Surgical site infections in Italian Hospitals: a prospective multicenter study

<p>Abstract</p> <p>Background</p> <p>Surgical site infections (SSI) remain a major clinical problem in terms of morbidity, mortality, and hospital costs. Nearly 60% of SSI diagnosis occur in the postdischarge period. However, literature provides little information on risk factors associated to in-hospital and postdischarge SSI occurrence. A national prospective multicenter study was conducted with the aim of assessing the incidence of both in-hospital and postdisharge SSI, and the associated risk factors.</p> <p>Methods</p> <p>In 2002, a one-month, prospective national multicenter surveillance study was conducted in General and Gynecological units of 48 Italian hospitals. Case ascertainment of SSI was carried out using standardized surveillance methodology. To assess potential risk factors for SSI we used a conditional logistic regression model. We also reported the odds ratios of in-hospital and postdischarge SSI.</p> <p>Results</p> <p>SSI occurred in 241 (5.2%) of 4,665 patients, of which 148 (61.4%) during in-hospital, and 93 (38.6%) during postdischarge period. Of 93 postdischarge SSI, sixty-two (66.7%) and 31 (33.3%) were detected through telephone interview and questionnaire survey, respectively. Higher SSI incidence rates were observed in colon surgery (18.9%), gastric surgery (13.6%), and appendectomy (8.6%). If considering risk factors for SSI, at multivariate analysis we found that emergency interventions, NNIS risk score, pre-operative hospital stay, and use of drains were significantly associated with SSI occurrence. Moreover, risk factors for total SSI were also associated to in-hospital SSI. Additionally, only NNIS, pre-operative hospital stay, use of drains, and antibiotic prophylaxis were associated with postdischarge SSI.</p> <p>Conclusion</p> <p>Our study provided information on risk factors for SSI in a large population in general surgery setting in Italy. Standardized postdischarge surveillance detected 38.6% of all SSI. We also compared risk factors for in-hospital and postdischarge SSI, thus providing additional information to that of the current available literature. Finally, a large amount of postdischarge SSI were detected through telephone interview. The evaluation of the cost-effectiveness of the telephone interview as a postdischarge surveillance method could be an issue for further research.</p

A multi-element psychosocial intervention for early psychosis (GET UP PIANO TRIAL) conducted in a catchment area of 10 million inhabitants: study protocol for a pragmatic cluster randomized controlled trial

Multi-element interventions for first-episode psychosis (FEP) are promising, but have mostly been conducted in non-epidemiologically representative samples, thereby raising the risk of underestimating the complexities involved in treating FEP in 'real-world' services

Intermittent conditioning of library archives: Microclimate analysis and energy impact

Libraries and archives house a majority of cultural heritage objects. The main purpose of libraries and archives is to provide suitable indoor climate conditions for preservation of their collection. In general, a large bulk of hygroscopic material is present which aids stable indoor climate conditions. Limited disturbances due to visitor presence occur in repositories and excludes to a large extent thermal comfort requirements. Library archives show potential of more tolerant setpoint control with permissible fluctuations. Little research is present into dynamic setpoint control and intermittent conditioning in libraries and archives. The aim of this study is to explore the possibility for intermittent conditioning and dynamic setpoint control on the energy impact and microclimate behavior in a library case study in The Netherlands. By means of a hygrothermal monitoring campaign from August 2016 to August 2017 the current indoor climate has been assessed under regular conditions and intervention periods (summer and winter) where the air handling unit was turned off. Both temporal and spatial measurements provided important information on microclimate behavior of the investigated repositories. A validated multi-zone model was used to investigate multiple setpoint strategies. Results show the potential of intermittent conditioning depending on whether dynamic setpoint conditions are used during operational hours (e.g. ASHRAE climate classes). If static conditions are applied, energy demand increases significantly, however, under dynamic setpoint control significant energy savings are possible. The lifetime multiplier is used to assess the chemical risks. The majority of investigated setpoint strategies show increased chemical risk

Intermittent conditioning of library archives:Microclimate analysis and energy impact

\u3cp\u3eLibraries and archives house a majority of cultural heritage objects. The main purpose of libraries and archives is to provide suitable indoor climate conditions for preservation of their collection. In general, a large bulk of hygroscopic material is present which aids stable indoor climate conditions. Limited disturbances due to visitor presence occur in repositories and excludes to a large extent thermal comfort requirements. Library archives show potential of more tolerant setpoint control with permissible fluctuations. Little research is present into dynamic setpoint control and intermittent conditioning in libraries and archives. The aim of this study is to explore the possibility for intermittent conditioning and dynamic setpoint control on the energy impact and microclimate behavior in a library case study in The Netherlands. By means of a hygrothermal monitoring campaign from August 2016 to August 2017 the current indoor climate has been assessed under regular conditions and intervention periods (summer and winter) where the air handling unit was turned off. Both temporal and spatial measurements provided important information on microclimate behavior of the investigated repositories. A validated multi-zone model was used to investigate multiple setpoint strategies. Results show the potential of intermittent conditioning depending on whether dynamic setpoint conditions are used during operational hours (e.g. ASHRAE climate classes). If static conditions are applied, energy demand increases significantly, however, under dynamic setpoint control significant energy savings are possible. The lifetime multiplier is used to assess the chemical risks. The majority of investigated setpoint strategies show increased chemical risk.\u3c/p\u3

Energy efficient HVAC control in historical buildings: a case study for the Amsterdam Museum

Museums are often located in historical buildings. To provide suitable housing in a historical building for a museum, these buildings are usually adapted to suit the need for object preservation through HVAC control. Maintaining a strict indoor climate and limiting short fluctuations in indoor temperature and indoor relative humidity reduces risk on objects. However, this also results in a rather high energy demand and therefore rather high costs. Previous research showed the energy conservation possibilities for a museum with state-of-the-art building envelope by adapting setpoint strategies. A gap in literature is present in applying these strategies in historical museum buildings. The aim of this study is to make use of different setpoint strategies to provide an indication of possible energy conservation for a historical museum building with respect to object preservation and thermal comfort. The method used consists of a measurement campaign to establish the current indoor climate and a simulation study with different climate control strategies. The simulation study provides possibilities to assess energy efficient control strategies with preservation of valuable museum objects in mind. The Amsterdam Museum serves as a case study during this research. With the data obtained during the measurement campaign, a hygrothermal zone-simulation model was calibrated. The results of the different climate control strategies present the energy saving potential for historical museum buildings. It is concluded that using the adaptive thermal comfort guideline for temperature during opening hours, and letting the collection criteria developed by ASHRAE's climate classes determine the relative humidity during the day, can save up to approximately 15% for a historical museum building without increasing the risk to the collection