Enterobacteriaceae Antibiotic Resistance in Ready-to-Eat Foods Collected from Hospital and Community Canteens: Analysis of Prevalence

Foodborne diseases and antibiotic resistance are serious widespread health problems in the contemporary world. In this study, we compared the microbiological quality of ready-to-eat (RTE) foods found in community canteens versus hospital canteens in Rome, Italy, focusing on detection and quantification of Enterobacteriaceae and the antibiotic resistance of these bacteria. Our findings show a remarkable difference in Enterobacteriaceae contamination between RTE foods distributed in community canteens (33.5% of samples) and those distributed in hospital canteens (5.3% of samples). This result highlights greater attention to good manufacturing practices and good hygiene practices by the food operators in hospitals compared with food operators in community canteens. As expected, a higher percentage of cold food samples (70.9%) than of hot food samples (10.8%) were positive for these bacteria. Excluding the intrinsic resistance of each bacterial strain, 92.3% of the isolated strains were resistant to at least one antibiotic, and about half of the isolated strains were classified as multidrug resistant. The prevalence of multidrug-resistant strains was 50% in the community samples and 33.3% in hospital canteens. Our results indicate that approximately 38% of RTE foods provided in community canteens is not compliant with microbiological food safety criteria and could be a special risk for consumers through spread of antibiotic-resistant strains. Hygienic processing and handling of foods is necessary for both hospital and community canteens

Surveillance and control of antibiotic resistance in the mediterranean region

Antibiotic resistance is one of the most relevant problems in the healthcare: the growth of resistant microorganisms in healthcare settings is a worrisome threat, raising length to stay (LOS), morbidity and mortality in those patients. The importance of the antibiotic resistance and its spread around the world, gave rise to the activation of several surveillance systems, based especially on the collection of laboratory data to local or national level. The objective of this work is to carry out a review of the scientific literature existing on the topic and scientific activities related to surveillance of antibiotic resistance in the countries bordering the Mediterranean Sea. Recent Data from European Centre for Disease Prevention and Control (November 2015) show, for different combinations bacterium-drug, an increase of resistance from North to South and from West to East of Europe. It is of particular concern the phenomenon of resistance carried out by some gram-negative, specifically Klebsiella pneumoniae and Escherichia coli to third-generation cephalosporin, often combined in opposition to fluoroquinolones and aminoglycosides. Is particularly high the incidence of resistance to carbapenems by strains of Enterobacteriaceae (Klebsiella included). The resistance exerted by MRSA (Methicillin-resistant Staphylococcus aureus) continues to be relevant, albeit showing some decline in recent years. The incidence of resistance carried on by Streptococcus pneumoniae is stable and is mainly relevant to macrolides. Finally, a significant increase in recording relatively exercised by Enterococcus faecium to Vancomycin. Detecting, preventing, and controlling antibiotic resistance requires strategic, coordinated, and sustained efforts. It also depends on the engagement of governments, academia, industry, healthcare providers, the general public, and the agricultural community, as well as international partners. Committing to combating antibiotic-resistant microbes does support patient care, economic growth, agriculture, and economic and national security

Critical Pathways for continuous quality improvement: a multicentric analysis on the management of patients with lung cancer in Italian best performing hospitals

Introduction: Critical pathways (CPs) are effective change management tools used to improve quality in healthcare nationally implemented in Italy in 2015. This study aims to map the country’s state-of-the-art regarding the adoption of CPs and to verify the existence of factors that determine the success of their implementation and the relative entity of their impact, by analysing the management of Lung Cancer (LC) as a case-study. Methods: Our methodology followed the SQUIRE guidelines for quality improvement reporting (2015). Starting from the 2017 ranking table published by the National Outcome Program, we selected and included in our sample all Italian hospitals who, according to Ministerial Decree n. 70/2015, met national quality threshold  for LC treatment. To investigate regional-level and hospital-level factors believed to be responsible for the successful implementation of a CP, a Google Modules questionnaire was constructed and sent to the selected facilities; subsequently, a web-based research was carried out for missing data.  Associations between variables were tested in STATA by means of correlation tests and a linear regression model.  Results: 41 hospitals matched our inclusion criteria. Of these, 68% defined an internal Lung Cancer Critical Pathway (LCCP). Our results confirmed the presence of critical success factors that favour the correct implementation of a LCCP. Conclusions: Notwithstanding the availability of CPs, their adoption in routine clinical practice still lacks consistency, suggesting the necessity to resort to digital solutions, to increment the level of regional commitment and workforce commitment and to reinforce quality standards monitoring

Impact evaluation of a Critical Pathway for patients with Clostridium difficile infection: a pre-post analysis in a Third Level Referral Center

Background: Clostridium Difficile Infections (CDIs) have been increasing both in incidence and in severity, representing a big public health concern. Aim: The aim of this study was to evaluate the impact of a recently implemented Critical Pathway (CP) focused on patients with CDI in an Italian Teaching Hospital. Methods: The CP implementation consisted of intervention aimed to faster diagnosis and appropriateness in admission and discharge point of care; activation of a multidisciplinary team; staff training; information to patients and caregivers.In a pre-post retrospective observational study, volume, process and outcome indicators were analyzed. Findings: A total of 228 patients (128 in 2013 and 100 in 2016) were included. A decrease in the absolute number of access to the Emergency Department (p = 0.02) and an increase in hospitalization in more appropriate ward (ie gastroenterology ward, p < 0.001) were found. The median hospital length of stay decreased from 20.5 (12.5–31) days in 2013 to 16.5 (7–31) days in 2016 (p = 0.05). With regards to outcome indicators, an increase of discharge to home and a decrease of discharge to long term facilities were showed (p = 0.01 both). Despite a reduction, no statically significant differences in mortality between 2013 and 2016 were revealed by the analysis. Conclusion: In conclusion, we found quality improvement in patient hospital management. Our experience confirms that the implementation of the CP increases the appropriateness in hospital quality of care. Keywords: Patient centeredness, Critical pathways, Clostridium Difficile infection, "Patient centered" analytic

SURVEILLANCE AND CONTROL OF ANTIBIOTIC RESISTANCE IN THE MEDITERRANEAN REGION

Antibiotic resistance is one of the most relevant problems in the healthcare: the growth of resistant micro-organisms in healthcare settings is a worrisome threat, raising length to stay (LOS), morbidity and mortality in those patients. The importance of the antibiotic resistance and its spread around the world, gave rise to the activation of several surveillance systems, based especially on the collection of laboratory data to local or national level. The objective of this work is to carry out a review of the scientific literature existing on the topic and scientific activities related to surveillance on antibiotic resistance in countries bordering the Mediterranean Sea. Recent Data from European Centre for Disease Prevention and Control (November 2015) show, for different combinations bacterium-drug, an increase of resistance from North to South and from West to East of Europe; it is particularly worrying the phenomenon of resistance carried out by some gram negative, specifically Klebsiella pneumoniae and Escherichia coli to third-generation cephalosporin, often combined in opposition to fluoroquinolones and amino glycosides. Is particularly relevant the incidence of resistance to carbapenems by strains of Enterobacteriaceae (Klebsiella included). The resistance exerted by MRSA (Methicillin-resistant Staphylococcus aureus) continues to be relevant, albeit showing some decline in recent years. The incidence of resistance carried on by Streptococcus pneumoniae is stable and is mainly relevant to macrolides. Finally, a significant increase in recording relatively exercised by Enterococcus faecium to Vancomycin. Detecting, preventing, and controlling antibiotic resistance requires strategic, coordinated, and sustained efforts. It also depends on the engagement of governments, academia, industry, healthcare providers, the general public, and the agricultural community, as well as international partners. Committing to combating antibiotic-resistant microbes will support patient care, economic growth, agriculture, and economic and national security

La formazione manageriale nelle scuole di Specializzazione

La Sanit\ue0 pubblica contribuisce alla sostenibilit\ue0 dei sistemi sanitari tramite strumenti di prevenzione, programmazione ed organizzazione dei servizi. In tale ambito le scelte per la salute devono tener conto del vincolo delle risorse. Organismi internazionali, letteratura scientifica e norme nazionali forniscono indicazioni su conoscenze e abilit\ue0 necessarie alla costruzione di un profilo manageriale. Una recente survey su specializzandi italiani in Sanit\ue0 Pubblica ha rivelato un significativo gap tra la formazione manageriale percepita come necessaria ed il training ricevuto. Pertanto \ue8 necessario individuare framework di riferimento e modalit\ue0 con cui le core competence rilevanti per la formazione manageriale degli specializzandi (leadership, system thinking, capacity building, pianificazione finanziaria e management) possano essere trasferite dal sistema formativo agli stessi. Si definisce Management l\u2019attivit\ue0 di orientare ad un risultato un set definito di risorse, in ottica di sostenibilit\ue0. I processi di decision- making manageriale in ambito sanitario si avvalgono del cosiddetto \u201cCiclo Manageriale\u201d, articolato in 4 momenti: Programmazione, Organizzazione e Valutazione, la quale consiste nel monitoraggio e nell\u2019 applicazione di azioni correttive. Questo ciclo \ue8 aperto, costituendo cos\uec una spirale di miglioramento continuo. Pi\uf9 recentemente si \ue8 evidenziato come anche la funzione di leadership si sviluppi secondo fasi di una dinamica interconnessa alla spirale sopradescritta. Tale decision-making si esercita in organizzazioni sanitarie caratterizzate da complessit\ue0, definita da relazioni che ne generano a loro volta delle altre. Le propriet\ue0 di tali sistemi complessi sono: non linearit\ue0, auto-organizzazione, sviluppo di nuove forme non riconducibili alla somma delle parti originarie, regole semplici che influenzano il sistema. A ci\uf2 si aggiunge il recente orientamento di gestire i servizi riconoscendo primato alla qualit\ue0 sui costi, rendendo la dimensione economica funzionale al raggiungimento di esiti clinici, appropriatezza, sicurezza, soddisfazione dell\u2019assistito, della comunit\ue0 e dei professionisti, questi ultimi sempre pi\uf9 inseriti in team multiprofessionali e multidisciplinari. Il management sanitario \u201cscientifico\u201d necessita di continui approfondimenti e di idonee metodologie e strumenti per il trasferimento di tali contenuti a specializzandi e professionisti di sanit\ue0 pubblica; tra questi ricordiamo l\u2019adozione dei principi dell\u2019Evidence-Based Management e dell\u2019Evidence-Based Healthcare. Utile \ue8 inoltre la condivisione di momenti formativi in prospettiva multidisciplinare e multiprofessionale per varie Scuole ed Operatori (Accademie di Sanit\ue0 Pubblica, momenti congressuali condivisi, materiale in rete, Skill Factories). La formazione si alimenta dei prodotti della ricerca; pertanto la ricerca valutativa sui modelli di policy e management che impattano su salute, processi assistenziali e utilizzo delle risorse ed equit\ue0 di accesso, rappresenta un fattore rilevante per la crescita dei professionisti in ambito manageriale. Cos\uec si realizza quella preziosa sinergia che unisce esperienze sul campo e metodo scientifico

Ischemic stroke: clinical pathway impact

Purpose – A clinical pathway for patients with acute ischemic stroke was implemented in 2014 by one Italian teaching hospital multidisciplinary team. The purpose of this paper is to determine whether this clinical pathway had a positive effect on patient management by comparing performance data. Design/methodology/approach – Volume, process and outcome indicators were analyzed in a pre-post retrospective observational study. Patients’ (admitted in 2013 and 2015) medical records with International Classification of Diseases, ICD-9 code 433.x (precerebral artery occlusion and stenosis), 434.x (cerebral artery occlusion) and 435.x (transient cerebral ischemia) and registered correctly according to hospital guidelines were included. Findings – An increase context-sensitive in-patient numbers with more severe cerebrovascular events and an increase in patient transfers from the Stroke to Neurology Unit within three days (70 percent, p¼0.25) were noted. Clinical pathway implementation led to an increase in patient flow from the Emergency Department to dedicated specialized wards such as the Stroke and Neurology Unit (23.7 percent, po0.001). Results revealed no statistically significant decrease in readmission rates within 30 days (5.7 percent, p¼0.85) and no statistically significant differences in 30-day mortality. Research limitations/implications – The pre-post retrospective observational study design was considered suitable to evaluate likely changes in patient flow after clinical pathway implementation, even though this design comes with limitations, describing only associations between exposure and outcome. Originality/value – Clinical pathway implementation showed an overall positive effect on patient management and service efficiency owing to the standardized application in time-dependent protocols and multidisciplinary/integrated care implementation, which improved all phases in acute ischemic stroke care

[Resident physicians' participation to the activities of the hospital hygiene unit in a teaching hospital: a pilot study]

INTRODUCTION: The Hospital Hygiene Unit ensures hospital patient safety, through surveillance and control of environmental conditions of risk. In this context, resident physicians in Hygiene and Preventive Medicine of the Catholic University of the Sacred Heart (UCSC) are required to attend the unit to acquire professional skills, for two months (four weeks in the first year of residency and four weeks in the second year). In the initial phase of the rotation, residents are acquainted with the organization and assigned activities. Ongoing meetings with the tutor take place to verify the progress of activities in which they are involved; verification of acquired skills is performed at the end of the period of attendance. The aim of the study was to evaluate resident doctors' opinions about their training experience, in order to assess the perceived quality and pursue continuous improvement of the training program. MATERIALS AND METHODS: A questionnaire was administered to resident physicians attending the first three years of residency; the survey consisted of 11 multiple choice questions on organization, attendance, training and overall satisfaction and 3 open-ended questions on strengths, weaknesses and proposals for improvement. RESULTS: Fourteen of 15 residents (93.3%) completed the questionnaire: seven were male, five were first-year residents, five were second-year and four were third-year residents. Overall, 78% gave a positive assessment of the quality of training; in particular, 11 of 14 residents reported that the experience was very relevant to their training in Hygiene and Preventive Medicine. Responses regarding the training organization were also mostly positive (75%), as were those regarding attendance (57%) and overall satisfaction (67%). Fifty percent reported difficulties in combining this internship with the other activities planned with their tutor. CONCLUSIONS: Positive opinions prevail in all areas of assessment, although there are some aspects that can be improved, including the possibility to extend the period of attendance. Overall, training activities at the Operative Unit of Hospital Hygiene are appreciated by resident physicians, who consider them an important opportunity for professional growth

Is the on site flu vaccination among health care workers effective? A Italian teaching hospital case

Background Influenza is a potentially severe but preventable respiratory infection that affects about 10% of general population leading to high morbidity and mortality especially in frail people. Seasonal flu vaccination is recommended among health care workers (HCWs) to protect immunocompromised patients, themselves and the whole hospital community. The low vaccination rate registered in Gemelli Teaching Hospital HCWs during last years called for new engaging approach to improve flu vaccination coverage. The aim of this study was to evaluate the efficacy of the On Site Vaccination (OSV) strategy and differences in flu vaccination coverage among medical and non-medical HCWs. Methods OSV sessions were organized by the Hospital Health Management in a random sample of Clinical Units (CU) of the Gemelli Teaching Hospital and realized between October and December 2016, whereas standard flu vaccination was proposed at all HCWs directly during the daily activity by Preventive Medicine Service (control CU). High risk CU were excluded from the study. Chi squared test was used to assess differences in flu vaccination coverage between groups; statistical significance was set at 0.05. Analyses were performed using STATA. Results OSV sessions involved 280 HCWs overall. Control CU accounted for a total of 1087 HCWs. Flu vaccination coverage in HCWs belonging to CU that received the intervention was higher compared to controls (15.7% vs 6.4%, p < 0.001), both in medical (25.8% vs 13.7%, p < 0.01) and non-medical (10.4% vs 3.5%, p < 0.001) HCWs. Medical doctors were more inclined to undergo vaccination than non-medical HCWs (16.6% vs 4.8%, p < 0.001), both in OSV CU (25.8% vs 10.4%, p < 0.001) and control CU (13.7% vs 3.5%, p < 0.001). Conclusions This additional OSV strategy to promote positive vaccination attitudes was effective in achieving higher flu vaccination coverage among medical and non-medical HCWs and therefore can be considered a valuable example to enhance prevention in hospital settings Key messages: Flu vaccination among HCWs is a fundamental goal to protect patients, themselves and the hospital community. When low vaccination rate is registered, new engaging approach, such as OSV, are necessary. Participative strategies, such as OSV, are important but not crucial to improve flu vaccination coverage among medical and non-medical HCWs and to protect, consequently, the whole hospital community