The dissemination of the Culture of Safety as an essential tool for the improvement of working conditions and production efficiency: Discussion on the multidisciplinary approach and main sub-topics

This paper deals with the dissemination of the Culture of Safety, a pivotal chain link towards the improvement of the Occupational Safety and Health - OS&H conditions. The Authors discuss the conditions affecting the work-related accidents and health impairments occurrence, together with the relationship between such criticalities and the dissemination of the Culture of Safety. The Culture of Safety still shows serious shortcomings at all levels, and in particular in situations –typically temporary or mobile construction sites and underground activities- characterized by high accident rates all over the world. The Culture of Safety, i.e. "the enduring value and prioritization of worker and public safety by each member of each group and in every level of an organization", gained in the last decades a wide attention in the international literature as a system of organized and systematic knowledge production, i.e. a specific science, for both its importance as a basic asset for prevention, and its typical multidisciplinary characteristics. A challenging and thorough analysis resulted in the proposal of an organic classification of the various aspects of the Culture of Safety into homogeneous sub-categories, precious as a key reading and reference for framing and analyzing in an unbiased approach the OS&H system faults in real cases

The dissemination of the culture of safety: Innovative experiences from important infrastructures and construction sites

The Culture of Safety is the enduring value and prioritization of worker and public safety by each member of each group and in every level of an organization (Von Thaden and Gibbons, 2008). First, the Authors provide some considerations on the roles, tasks and responsibilities of the subjects involved, and reiterate the importance of an approach involving a strong motivation for the figures with real decision-making power. Taken into account what emerged in the International Meeting “the basic role of the clients of great infrastructural operations in the promotion of the Culture of Safety: management and communication strategies, contractual aspects, case histories and best practices”, SiTI, Turin, Politecnico, May 12th 2017, the Authors discuss – coherent to the original structured classification of the various aspects of the Culture of Safety into specifically designed sub-categories- the critical Occupational and Community S&H issues, and the responses of the clients

Education: an essential tool for the dissemination of the Culture of Safety

The authors, operating within The General Safety Issues and Goals in Turin Universities -TGSIGTU research project, started from a thorough analysis of the International literature on the Culture of Safety, and made the challenging effort to classify and organize the covered sub-topics, highlighting in particular the sub-categories of Educational processes. It is important to underline that the goal of such a classification is to better manage the amount of information collected and not to compartmentalize the theme of Safety, universally recognized as a multidisciplinary Science. There are numerous examples of interventions aiming the goal of a widespread dissemination of the Culture of Safety, and different parameters that make them incomparable, but useful: among them, authors quote the audience they are addressed to. In particular: 1. The National Institute on Occupational Safety and Health - NIOSH developed the Youth@Work—Talking Safety to educate young people about essential information transferable across industries and occupations. 2. With a different audience, Politecnico di Torino, in cooperation with Occupational Medicine experts, Environment and Workplace Prevention Technicians from Università di Torino, and some experts of National Boards operating in Occupational Safety and Health - OS&H field, provides some bachelor courses on OS&H basics. 3. Furthermore, Politecnico provides general information and engineering-readiness skills focusing on some core competencies for post graduate students, employees and practitioners operating in the field of OS&H, and National Inspectorate such as: OS&H topics and discussion, Computer-aided systems as support in the analysis of scenarios, research projects about the advanced techniques for the analysis of accidents. All the activities are based on the assumption that education should be tailored for three main groups of people: • the new entry workforce; • medium-term employed workforce; • the experienced workforce. Moreover, a fourth category is raising. In fact, the third group is growing directly proportional to the ageing of the workforce, in turn connected to the raising of the retirement age. Similar considerations leaded European Occupational Safety and Health Administration - EU OSHA and NIOSH to develop research campaigns on the matter. The paper summarizes the approaches to the dissemination of the Culture of Safety to those various categories of people, in particular the main approaches developed in Politecnico di Torino, and suggests that these topics can be effectively addressed in parallel with the progress of knowledge in the technical fields

Occupational Risk Assessment and Management in a System Approach: the Why and the How

Occupational Safety and Health - OS&H problems still remain an important criticality in many Statistical classification of economic activities in the European Community - NACE sectors in Italy. Even if the official Italian statistical data published by National Institute for Work Injury Insurance - Inail show some fluctuations in the yearly accident and health impairment rates, the 3 fatalities/day figure proves difficult to modify, and the number of traditional and new professional diseases remains very impressive (officially approximately 2/year deadly diseases). An extensive and in deep analysis of a number of case histories, carried out by means of an innovative technique (namely the Computer aided Cause Consequence for Prevention - CCCP approach) conclusively proved that this unacceptable scenario results from the following causes: a - Hazard Factors (situations, materials, substances, organization, reasonably predictable faults and errors in terms of Worst Credible Case - WCC, etc.) poor Identification, directly involving the absence of special prevention countermeasures; b – Poor Risk Assessment, involving under or overestimation of the seriousness of some safety problems, and hence a misguided organization of the prevention; c – Poor Risk Management, basically in terms of lacking internal/external audits of situations/operations vs the Risk Assessment results, lacking risk assessment revision in case of scenery modifications, and lacking conservation along the time of the safety measures resulting from the risk assessment. A side cause of the modest success of the actions aimed to modify the previously mentioned concerning occupational safety scenery is that the Heinrich approach (prevention can be implemented from information on the frequency of deviations from a correct working situation) is applied in a generalized way without discussion. But the Heinrich model is based on a “Person Approach” (the misconduct of victims or colleagues is the main cause of deviation, in spite of the obvious consideration that they and they only are in direct contact with the Hazard Factor). A Guideline based on a System Approach (the system approach concentrates on the conditions under which individuals work and tries to build defences to avert errors or mitigate their effects) was developed and successfully tested in a number different situations. The basic principia of the guideline, coherent with both the 89/391 EEC Directive and the OS&H in quality criteria, can be summarized in a 3E list: E1 - Engineering: Prevention through Design – PtD, focused to guarantee the highest safety level technically achievable through comparative analysis of alternative solutions, and the possible faults, human errors included (a formal demonstration is necessary); E2 - Education: information, education and training actions at every hierarchic level, derived from a Risk Assessment and Management specially conceived for the situation under exam; E3 - Enforcement: checking with internal/external audits the preservation through time of the safety level made possible by the PtD approach, and consideration of further improvements made available by the technical and epidemiology improvements. The paper discusses the previous aspects, and the Why and the How of the suggested Occupational Risk Assessment and Management technique in a System Approach

Years of life that could be saved from prevention of hepatocellular carcinoma

BACKGROUND: Hepatocellular carcinoma (HCC) causes premature death and loss of life expectancy worldwide. Its primary and secondary prevention can result in a significant number of years of life saved. AIM: To assess how many years of life are lost after HCC diagnosis. METHODS: Data from 5346 patients with first HCC diagnosis were used to estimate lifespan and number of years of life lost after tumour onset, using a semi-parametric extrapolation having as reference an age-, sex- and year-of-onset-matched population derived from national life tables. RESULTS: Between 1986 and 2014, HCC lead to an average of 11.5 years-of-life lost for each patient. The youngest age-quartile group (18-61 years) had the highest number of years-of-life lost, representing approximately 41% of the overall benefit obtainable from prevention. Advancements in HCC management have progressively reduced the number of years-of-life lost from 12.6 years in 1986-1999, to 10.7 in 2000-2006 and 7.4 years in 2007-2014. Currently, an HCC diagnosis when a single tumour <2 cm results in 3.7 years-of-life lost while the diagnosis when a single tumour 65 2 cm or 2/3 nodules still within the Milan criteria, results in 5.0 years-of-life lost, representing the loss of only approximately 5.5% and 7.2%, respectively, of the entire lifespan from birth. CONCLUSIONS: Hepatocellular carcinoma occurrence results in the loss of a considerable number of years-of-life, especially for younger patients. In recent years, the increased possibility of effectively treating this tumour has improved life expectancy, thus reducing years-of-life lost

Wastewater-based epidemiology for early warning of SARS-COV-2 circulation: A pilot study conducted in Sicily, Italy

There is increasing evidence of the use of wastewater-based epidemiology to integrate conventional monitoring assessing disease symptoms and signs of viruses in a specific territory. We present the results of SARS-CoV-2 environmental surveillance activity in wastewater samples collected between September 2020 and July 2021 in 9 wastewater treatment plants (WTPs) located in central and western Sicily, serving over 570,000 residents. The presence of SARS-CoV-2, determined in 206 wastewater samples using RT-qPCR assays, was correlated with the notified and geo-referenced cases on the areas served by the WTPs in the same study period. Overall, 51% of wastewater samples were positive. Samples were correlated with 33,807 SARS-CoV-2 cases, reported in 4 epidemic waves, with a cumulative prevalence of 5.9% among Sicilian residents. The results suggest that the daily prevalence of SARS-CoV-2 active cases was statistically significant and higher in areas with SARS-CoV-2 positive wastewater samples. According to these findings, the proposed method achieves a good sensitivity profile (78.3%) in areas with moderate or high viral circulation (≥133 cases/100,000 residents) and may represent a useful tool in the management of epidemics based on an environmental approach, although it is necessary to improve the accuracy of the process

The PaO2/FiO2 ratio on admission is independently associated with prolonged hospitalization in COVID-19 patients.

Introduction: The early identification of factors that predict the length of hospital stay (HS) in patients affected by coronavirus desease (COVID-19) might assist therapeutic decisions and patient flow management. Methodology: We collected, at the time of admission, routine clinical, laboratory, and imaging parameters of hypoxia, lung damage, inflammation, and organ dysfunction in a consecutive series of 50 COVID-19 patients admitted to the Respiratory Disease and Infectious Disease Units of the University Hospital of Sassari (North-Sardinia, Italy) and alive on discharge. Results: Prolonged HS (PHS, >21 days) patients had significantly lower PaO2/FiO2 ratio and lymphocytes, and significantly higher Chest CT severity score, C-reactive protein (CRP) and lactic dehydrogenase (LDH) when compared to non-PHS patients. In univariate logistic regression, Chest CT severity score (OR = 1.1891, p = 0.007), intensity of care (OR = 2.1350, p = 0.022), PaO2/FiO2 ratio (OR = 0.9802, p = 0.007), CRP (OR = 1.0952, p = 0.042) and platelet to lymphocyte ratio (OR = 1.0039, p = 0.036) were significantly associated with PHS. However, in multivariate logistic regression, only the PaO2/FiO2 ratio remained significantly correlated with PHS (OR = 0.9164; 95% CI 0.8479-0.9904, p = 0.0275). In ROC curve analysis, using a threshold of 248, the PaO2/FiO2 ratio predicted PHS with sensitivity and specificity of 60% and 91%, respectively (AUC = 0.780, 95% CI 0.637-0.886 p = 0.002). Conclusions: The PaO2/FiO2 ratio on admission is independently associated with PHS in COVID-19 patients. Larger prospective studies are needed to confirm this finding

Antifungal susceptibility of invasive yeast isolates in Italy: the GISIA3 study in critically ill patients

<p>Abstract</p> <p>Background</p> <p>Yeasts are a common cause of invasive fungal infections in critically ill patients. Antifungal susceptibility testing results of clinically significant fungal strains are of interest to physicians, enabling them to adopt appropriate strategies for empiric and prophylactic therapies. We investigated the antifungal susceptibility of yeasts isolated over a 2-year period from hospitalised patients with invasive yeast infections.</p> <p>Methods</p> <p>638 yeasts were isolated from the blood, central venous catheters and sterile fluids of 578 patients on general and surgical intensive care units and surgical wards. Etest strips and Sensititre panels were used to test the susceptibility of the isolates to amphotericin B, anidulafungin, caspofungin, fluconazole, itraconazole, posaconazole and voriconazole in 13 laboratories centres (LC) and two co-ordinating centres (CC). The Clinical and Laboratory Standards Institute (CLSI) reference broth microdilution method was used at the CCs for comparison.</p> <p>Results</p> <p>Etest and Sensititre (LC/CC) MIC₉₀values were, respectively: amphotericin B 0.5/0.38, 1/1 mg/L; anidulafungin 2/1.5 and 1/1 mg/L; caspofungin 1/0.75 and 0.5/0.5 mg/L; fluconazole 12/8 and 16/16 mg/L; itraconazole 1/1.5, 0.5/0.5 mg/L; posaconazole 0.5 mg/L and voriconazole 0.25 mg/L for all. The overall MIC₉₀values were influenced by the reduced susceptibility of <it>Candida parapsilosis </it>isolates to echinocandins and a reduced or lack of susceptibility of <it>Candida glabrata </it>and <it>Candida krusei </it>to azoles, in particular fluconazole and itraconazole. Comparison of the LC and CC results showed good Essential Agreement (90.3% for Etest and 92.9% for Sensititre), and even higher Categorical Agreement (93.9% for Etest and 96% for Sensititre); differences were observed according to the species, method, and antifungal drug. No cross-resistance between echinocandins and triazoles was detected.</p> <p>Conclusions</p> <p>Our data confirm the different antifungal susceptibility patterns among species, and highlight the need to perform antifungal susceptibility testing of clinically relevant yeasts. With the exception of a few species (e.g. <it>C. glabrata </it>for azoles and <it>C. parapsilosis </it>for echinocandins), the findings of our study suggest that two of the most widely used commercial methods (Etest and Sensititre) provide valid and reproducible results.</p

DECLINE OF PREVALENCE OF RESISTANCE ASSOCIATED SUBSTITUTIONS TO NS3 AND NS5A INHIBITORS AT DAA- FAILURE IN HEPATITIS C VIRUS IN ITALY OVER THE YEARS 2015 TO 2018

Background: A minority of patients fails to eliminate HCV and resistance-associated substitutions (RASs) are commonly detected at failure of interferon-free DAA regimens . Methods: Within the Italian network VIRONET-C, the prevalence of NS3/NS5A/NS5B RASs was retrospectively evaluated in patients who failed an EASL recommended DAA-regimen in 2015-2018 . The geno2pheno system and Sorbo MC et al. Drug Resistance Updates 2018 were used to infer HCV- genotype/subtype and predict drug resistance . The changes in prevalence of RASs over time were evaluated by chi-square test for trend, predictors of RASs at failure were analysed by logistic regression . Results: We included 386 HCV infected patients: 75% males, median age was 56 years (IQR 52-61), metavir fibrosis stage F4 in 76%; 106 (28%) were treatment- experienced: 91 (86%) with IFN-based treatments, 26 (25%) with DAAs. Patients with HIV and HBV coinfection were 10% (33/317) and 8% (6/72), respectively. HCV genotype was 1b in 122 pts (32%), 3 in 109 (28%), 1a in 97 (25%), 4 in 37 (10%), 2 in 21 (5%). DAA regimens were: LDV/SOF in 115 (30%), DCV/SOF in 103 (27%), 3D in 83 (21%), EBR/GRZ in 32 (8%), VEL/SOF in 29 (7%), GLE/PIB in 18 (5%) and 2D in 6 (2%); ribavirin was administered in 123 (32%) . The NS5A fasta-sequence was available for all patients, NS5B for 361 (94%), NS3 for 365 (95%) . According to the DAA failed the prevalence of any RASs was 90%, namely 80/135 (59%) in NS3, 313/359 (87%) in NS5A, 114/286 (40%) in NS5B . The prevalence of any RASs significantly declined from 2015 to 2018 (93% vs 70%, p=0.004): NS5A RASs from 90% to 72% (p=0 .29), NS3 RASs from 74% to 18% (p&lt;0 .001), while NS5B RASs remained stable . Independent predictors of any RASs included advanced fibrosis (AOR 6.1, CI 95% 1.8-20.3, p=0 .004) and genotype (G2 vs G1a AOR 0 .03, CI 95% 0 .002- 0 .31, p=0 .004; G3 vs G1a AOR 0 .08, CI 95% 0 .01-0 .62, p=0 .02; G4 vs G1a AOR 0 .05, CI 95% 0 .006-0 .46, p=0 .008), after adjusting for age, previous HCV treatment and year of genotype . Notably, full activity was predicted for GLE/PIB in 75% of cases and for at least two components of VEL/SOF/VOX in 53% of cases, no case with full-resistance to either regimen was found . Conclusion: Despite decreasing prevalence over the years, RASs remain common at virological failure of DAA treatment, particularly in patients with the highest grade of liver fibrosis. The identification of RASs after failure could play a crucial role in optimizing retreatment strategies

Valutazione di Health Technology Assessment del sistema di sanificazione biologico a base di probiotici del genere Bacillus (PCHS)

Le infezioni correlate all’assistenza: priorità per la salute pubblica Epidemiologia delle infezioni correlate all’assistenza in Italia e loro impatto per la salute pubblica Sistemi di sanificazione attualmente disponibili in Italia Il Probiotic Cleaning Hygiene System (PCHS): caratteristiche della tecnologia, aspetti di efficacia e sicurezza Un sistema di sanificazione a base di probiotici per la riduzione delle infezioni correlate all’assistenza e la resistenza antimicrobica: analisi dell’impatto sul budget Impatto ambientale per la salute pubblica degli attuali sistemi di sanificazione di ambienti/superfici in setting assistenziale e comunitario e potenziali benefici dei nuovi sistemi innovativi Analisi delle principali raccomandazioni nazionali su sanificazione e disinfezione degli ambienti sanitari Valutazione etica dell’utilizzo del Probiotic Cleaning Hygiene System (PCHS) in Italia Elementi chiave per il processo decisional