A management model for Hospital Hygiene Unit: evidence-based pro-active surveillance of potential environmental sources of infection in order to prevent patient’s risk.

Introduction. The aim of this study is to describe a proactive surveillance system of food, water and environmental surfaces, in order to avoid Healthcare-Associated Infections (HAIs) from hospital environment. Methods. It is a retrospective descriptive study. The surveillance system consists of two integrated phases: pre-analytic and post-analytic. The activities are distinguished in ordinary control activities, performed after scheduled and shared surveys, and compliance activities, performed when it is necessary to establish the adequacy of the destination use, for example opening a new ward. Results. A total of 1,470 Samples were collected and 539 Reports were generated across the five-year study period. Water for human consumption procedure: a statistically significant trend was found only in the total number of Samples collected (p < 0.001). Legionella spp. infection water risk procedure: all Samples and Reports, with the exception of Compliance Report Samples, showed a statistically significant trend (p < 0.001). Pseudomonas aeruginosa water risk procedure: only Ordinary Reports and Compliance Report Samples trend were statistically significant (p = 0.002 and p = 0.028 respectively). Effectiveness of surface sanitization procedure: no trend was statistically significant (p < 0.05). Hospital catering and food surfaces procedure: Samples and Reports yearly number was constant, no trend analysis was performed. HAIs prevalence was never over 5% in the hospital under study. Conclusions. This surveillance system of water, food and environmental surfaces represents an innovative way of approaching hospital safety for patients and personnel because it overcomes the limitations due to a classic approach limited to a laboratory analytic phase only, according to the best available scientific evidence

Networks as a way to hospital and primary/community care integration: findings from a narrative review of the main international models

: Background Healthcare systems are complex systems. Achieving financial, social, and environmental sustainability of these systems requires a high degree of integration and coordination at all levels, especially between acute-care settings and primary/community care services. Some authors have, therefore, suggest redirecting integrated healthcare research towards the network theory and network concepts as a useful lens. Objective The current paper proposes to investigate the existence, the institutional level of formalization and the degree of development of hospital/primary-community care Networks currently present in the main types of healthcare systems worldwide by studying an appropriate selection of representative countries for each system typology. Materials and Methods A narrative review of the scientific and gray literature following the methodology by Green et al. was, therefore, conducted to describe hospital and primary/community care networks and their integration/coordination in the main international models. To select these models, one country with the current highest life expectancy at birth for each of the B öhm's five healthcare system categories was chosen. The grade of integration of the Networks retrieved for each State was therefore qualitatively appraised (high, medium or low degree), following Valentijn's framework. Results The networks retrieved show: in Norway, Australia and Japan both at the government/ national and at the regional/lower level/other a high degree of systemic, organizational, normative and functional integration; in Switzerland both at the government/national and at the regional/lower level/other a medium degree of systemic, organizational, normative and functional integration; in the USA at the governmental/institution level a low degree of systemic, organizational and normative integration, with a medium degree of functional integration and at the regional/lower level/other integration a low degree of systemic and normative integration with medium degree of organization integration and high degree of functional integration. Discussion The high levels and degree of hospital/primary - community care integration of Norway, Australia and Japan are in line with what could be expected from the universalistic healthcare system in place. The medium levels of integration of Switzerland are also in line with what the Social health insurance system and, especially, the cantonal system. The low levels of integration of the USA are in line with the privatistic healthcare systems. However, a medium degree was found for functional integration probably due to its unparalleled technological advancement. Conclusions The study shows how the levels of hospital/primary-community care integration are connected to the specific healthcare system in place in each country. COVID-19 showed how complex systems like healthcare systems had to reconfigure themselves to reach high levels of integration in small time to be able to save lives and contain the spread of the virus. These results will prove useful for policymakers, healthcare and public health professionals in the task of establishing effective Networks to achieve high levels of integration in their institutions

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

COVID-19 e cure palliative: l'impatto della pandemia sull'erogazione delle cure palliative a pazienti non COVID

SCOPO: Le Cure Palliative possono svolgere un ruolo cruciale durante una pandemia. Le ripercussioni della pandemia da COVID-19 sono state avvertite non solo sui pazienti COVID suscettibili di Cure Palliative, ma anche su tutti gli altri pazienti complessi che non hanno contratto l’infezione. La popolazione di pazienti suscettibili di Cure Palliative è cambiata in relazione al tempo considerato (pre-lockdown, lockdown e post-lockdown). Questo studio ha l’obiettivo di analizzare se e in che misura sia variata l’erogazione delle Cure Palliative a pazienti non COVID durante la pandemia da COVID-19, nel contesto di un Policlinico Universitario. METODO: Per studiare come la pandemia da COVID-19 ha influenzato l’attività delle Cure Palliative intraospedaliere, si sono presi in esame i pazienti ricoverati dal 1° ottobre 2019 al 30 settembre 2020 valutati dal team di Cure Palliative. Questo periodo è stato così ripartito: - Pre-lockdown (periodo 1): dal 1° ottobre 2019 al 31 gennaio 2020 - Lockdown (periodo 2): dal 1° febbraio 2020 al 31 maggio 2020 - Post-lockdown (periodo 3): dal 1° giugno 2020 al 30 settembre 2020. Per ognuno di questi periodi sono stati studiati: - numero di pazienti ricoverati - età - genere - diagnosi (oncologica versus non oncologica) - durata della degenza - numero di pazienti deceduti durante il ricovero - tempo di latenza per attivazione delle Cure Palliative: - durata della degenza dopo la consulenza di Cure Palliative - numero medio di consulenze di Cure Palliative per paziente. - dimissione a domicilio vs dimissione in hospice. RISULTATI: Si è analizzato l’andamento del numero dei pazienti ricoverati per cui è stata richiesta una valutazione di Cure Palliative, con evidenza di un trend lineare positivo statisticamente significativo. Il numero di pazienti studiati è stato pari a 1168. Il numero di consulenze di Cure Palliative è stato pari a 1482. Dei 1168 pazienti, 264 sono deceduti. Per 883 pazienti è nota la modalità di dimissione: 454 a in Cure Palliative domiciliari (53,22%) e 399 in hospice (46,78%). Stratificando il dato nei tre periodi si ottengono i seguenti risultati. Nel pre-lockdown: 110 pazienti in Cure Palliative domiciliari (55,47%) vs 147 pazienti in hospice (44,53%). Nel lockdown: 160 pazienti in Cure Palliative domiciliari (43,26%) vs 122 pazienti in hospice (56,74%). Nel post-lockdown: 184 pazienti in Cure Palliative domiciliari (41,40%) vs 130 pazienti in hospice (58,60%). L’attività del team di Cure Palliative è aumentata nel periodo considerato. Durante il lockdown, la popolazione valutata dal team di Cure Palliative è stata più anziana rispetto al pre-lockdown. Ciò potrebbe essere attribuito ad un “effetto selezione” dei pazienti giovani, che sono rimasti a casa, evitando il rischio di contagio al quale si sarebbero sottoposti recandosi in ospedale. La durata della degenza si è ridotta sia durante lockdown sia durante il post-lockdown. Questa variabile è determinata dalla latenza per l’attivazione delle Cure Palliative (che dipende dall’efficienza dei medici dei reparti ospedalieri) e dal tempo che decorre dall’attivazione delle Cure Palliative alla dimissione o al decesso del paziente (che dipende dall’efficienza del team di Cure Palliative e dalla disponibilità del territorio). Il tempo di latenza per l’attivazione delle Cure Palliative è diminuito nel post-lockdown, rispetto al pre-lockdown. Ciò potrebbe essere dovuto ad una maggiore efficienza dei medici dei reparti ospedalieri, dovuto al maggior carico di pazienti degenti. Il tempo di degenza dopo l’attivazione delle Cure Palliative è diminuito sia nel lockdown sia nel post-lockdown. Questo potrebbe essere imputabile ad una maggiore disponibilità, in termini di posti letto liberi, del territorio ad accogliere pazienti, e ad una maggiore “spinta dimissiva” da parte dei reparti ospedalieri, a causa dell’aumento di ricoveri in questi due periodi. Il tasso di mortalità intraospedaliera è rimasto invariato. Ciò potrebbe essere indice di un’ottima qualità dell’assistenza a pazienti fragili in un contesto pandemico in cui la mortalità è generalmente aumentata. Il numero medio di consulenze di Cure Palliative per paziente è aumentato durante lockdown e post-lockdown. Questo potrebbe essere dovuto all’aumento di complessità dei pazienti ricoverati durante questi due periodi. La maggiore complessità dei pazienti ricoverati durante il lockdown è imputabile al fatto che durante quel periodo si sono recati presso l’ospedale maggiormente i pazienti in condizioni cliniche generali più gravi, che non hanno potuto evitare il rischio di contagio restando presso la propria abitazione. Nel post-lockdown, la complessità maggiore dei pazienti potrebbe essere imputabile al fatto che essi, non essendosi recati in ospedale durante il lockdown, hanno poi presentato un peggioramento delle condizioni cliniche tale per cui, una volta fatto l’accesso in ospedale, hanno presentato subito bisogni complessi suscettibili di Cure Palliative. L’analisi ha messo in evidenza una differenza significativa tra la percentuale di pazienti dimessi in hospice versus pazienti dimessi in Cure Palliative domiciliari. Durante il lockdown ed il post-lockdown sono aumentati i pazienti dimessi in Cure Palliative domiciliari rispetto ai pazienti dimessi in hospice. Ciò potrebbe essere imputabile a diversi fattori. In primis, durante il lockdown e il post-lockdown si sono verificate chiusure di alcuni hospice, dovute a presenza di casi di SARS-CoV-2 all’interno del presidio sanitario. Ciò ha fatto sì che la dimissione dei pazienti fosse dirottata sulle Cure Palliative domiciliari. Inoltre, le visite dei parenti ai pazienti degenti negli hospice sono state bloccate durante il lockdown, e limitate durante il post-lockdown. Questo potrebbe essere stato un fattore contribuente all’aumento della percentuale di pazienti dimessi in Cure Palliative domiciliari. La preferenza dei familiari nei confronti del setting domiciliare è stata dovuta anche al timore che i pazienti contraessero l’infezione da SARS-CoV-2 essendo ricoverati in un presidio sanitario, piuttosto che proseguendo le cure presso il proprio domicilio. CONCLUSIONI: Questo studio ha analizzato l’impatto della pandemia da COVID-19 sull’erogazione delle Cure Palliative. Le modifiche si sono sostanziate soprattutto sulla dimissione dei pazienti, essendo variata la destinazione di dimissione in base alla diversa “ricettività” del territorio durante il lockdown e il post-lockdown. Sono necessari ulteriori studi per verificare se la pandemia da COVID-19 ha avuto un impatto anche su altri aspetti del sistema delle Cure Palliative, sia all’interno dell’ospedale sia a livello del territorio

Community-based participatory research to engage disadvantaged communities: Levels of engagement reached and how to increase it. A systematic review

Community-based participatory research (CBPR) is one of the most used community engagement frameworks to promote health changes in vulnerable populations. The more a community is engaged, the more a program can impact the social determinants of health. The present study aims to measure the level of engagement reached in randomized controlled trials (RCTs) using CBPR in disadvantaged populations, and to find out the CBPR components that better correlate with a higher level of engagement. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Embase, Web of Science, MEDLINE, Cochrane and Scopus databases were queried. Engagement level was assessed using the revised version of IAP2 spectrum, ranging from "inform" to "shared leadership" . Fifty-one RCTs were included, belonging to 36 engagement programs. Fourteen CBPR reached the highest level of engagement. According to the multivariate logistic regression, a pre-existing community intervention was associated with a higher engagement level (OR = 10.08; p<0.05).The variable "institutional funding" was perfectly correlated with a higher level of engagement. No correlation was found with income status or type of preventive programs. A history of collaboration seems to influence the effectiveness in involving communities burdened with social inequities, so starting new partnerships remains a public health priority to invest on. A strong potentiality of CBPR was described in engaging disadvantaged communities, addressing social determinants of health.The key findings described above should be taken into account when planning a community engagement intervention, to build up an effective collaborative field between researchers and population

Nudging Interventions on Alcohol and Tobacco Consumption in Adults: A Scoping Review of the Literature

: Background: The World Health Organization identified alcohol and tobacco consumption as the risk factors with a greater attributable burden and number of deaths related to non-communicable diseases. A promising technique aimed to modify behavioral risk factors by redesigning the elements influencing the choice of people is nudging. Methodology: A scoping review of the literature was performed to map the literature evidence investigating the use of nudging for tobacco and alcohol consumption prevention and/or control in adults. Results: A total of 20 studies were included. The identified nudging categories were increasing salience of information or incentives (IS), default choices (DF), and providing feedback (PF). Almost three-quarters of the studies implementing IS and half of those implementing PF reported a success. Three-quarters of the studies using IS in conjunction with other interventions reported a success whereas more than half of the those with IS alone reported a success. The PF strategy performed better in multi-component interventions targeting alcohol consumption. Only one DF mono-component study addressing alcohol consumption reported a success. Conclusions: To achieve a higher impact, nudging should be integrated into comprehensive prevention policy frameworks, with dedicated education sessions for health professionals. In conclusion, nudge strategies for tobacco and alcohol consumption prevention in adults show promising results. Further research is needed to investigate the use of nudge strategies in socio-economically diverse groups and in young populations

Enhancement of Vaccination Attitude and Flu Vaccination Coverage among Pregnant Women Attending Birthing Preparation Course

Most vaccinations are recommended within the 15th month of life, in order to reduce risks and to protect children from the initial stages of their lives. A vaccination training session was carried out during the birthing preparation course, aimed at increasing the attitude toward vaccination in maternal-child age. A questionnaire on vaccination awareness was administered before and after the training session and on-site flu vaccination was offered to women and their companions. The percentage of participants who consider the preparatory course a useful tool to obtain information about vaccines increases significantly from 30.34% at pre-intervention to 64.56% at post-intervention (p p < 0.001). In total, 48 out of 119 (40.34%) pregnant women participating in the course and 39 companions were vaccinated for influenza. Vaccination knowledge and attitude significantly increased after a training session dedicated to vaccination as a part of the pregnant pre-birth course, whose aim can be therefore extended to the management of the health of the child, well beyond the period of pregnancy, according to the life-course approach to health

Queueing Theory and COVID-19 Prevention: Model Proposal to Maximize Safety and Performance of Vaccination Sites

INTRODUCTION: COVID-19 (Coronavirus Disease 19) has rapidly spread all around the world. Vaccination represents one of the most promising counter-pandemic measures. There is still little specific evidence in literature on how to safely and effectively program access and flow through specific healthcare settings to avoid overcrowding in order to prevent SARS-CoV-2 transmission. Literature regarding appointment scheduling in healthcare is vast. Unpunctuality however, especially when targeting healthcare workers during working hours, is always possible. Therefore, when determining how many subjects to book, using a linear method assuming perfect adhesion to scheduled time could lead to organizational problems. METHODS: This study proposes a “Queuing theory” based approach. A COVID-19 vaccination site targeting healthcare workers based in a teaching hospital in Rome was studied to determine real-life arrival rate variability. Three simulations using Queueing theory were performed. RESULTS: Queueing theory application reduced subjects queueing over maximum safety requirements by 112 in a real-life based vaccination setting, by 483 in a double-sized setting and by 750 in a mass vaccination model compared with a linear approach. In the 3 settings, respectively, the percentage of station's time utilization was 98.6, 99.4 and 99.8%, while the average waiting time was 27.2, 33.84, and 33.84 min. CONCLUSIONS: Queueing theory has already been applied in healthcare. This study, in line with recent literature developments, proposes the adoption of a Queueing theory base approach to vaccination sites modeling, during the COVID-19 pandemic, as this tool enables to quantify ahead of time the outcome of organizational choices on both safety and performance of vaccination sites

A management model for Hospital Hygiene Unit: evidence-based proactive surveillance of potential environmental sources of infection in order to prevent patient's risk

Introduction. The aim of this study is to describe a proactive surveillance system of food, water and environmental surfaces, in order to avoid Healthcare-Associated Infections (HAIs) from hospital environment. Methods. It is a retrospective descriptive study. The surveillance system consists of two integrated phases: pre-analytic and post-analytic. The activities are distinguished in ordinary control activities, performed after scheduled and shared surveys, and compliance activities, performed when it is necessary to establish the adequacy of the destination use, for example opening a new ward. Results. A total of 1,470 Samples were collected and 539 Reports were generated across the five-year study period. Water for human consumption procedure: a statistically significant trend was found only in the total number of Samples collected (p &lt; 0.001). Legionella spp. infection water risk procedure: all Samples and Reports, with the exception of Compliance Report Samples, showed a statistically significant trend (p &lt; 0.001). Pseudomonas aeruginosa water risk procedure: only Ordinary Reports and Compliance Report Samples trend were statistically significant (p = 0.002 and p = 0.028 respectively). Effectiveness of surface sanitization procedure: no trend was statistically significant (p &lt; 0.05). Hospital catering and food surfaces procedure: Samples and Reports yearly number was constant, no trend analysis was performed. HAIs prevalence was never over 5% in the hospital under study. Conclusions. This surveillance system of water, food and environmental surfaces represents an innovative way of approaching hospital safety for patients and personnel because it overcomes the limitations due to a classic approach limited to a laboratory analytic phase only, according to the best available scientific evidence

Buffer spaces in healthcare facilities: strategies for managing and designing strategic areas

Introduction: The recent covid-19 experience highlighted the difficulty of healthcare facilities in responding promptly to emergencies. hospitals had to reorganize their spaces, suspending the ordinary medical activities for ensuring the emergency management of the patients’ surplus. A working group of the postgraduate training course in healthcare management by Altems school in Rome conducted a survey on the buffer space (bs), which could support, in case of emergency, the hospitals. Methodology: The team elaborated a double questionnaire to be administered respectively to healthcare staff and designers with a series of questions aimed at understanding the features of bss. the questions were divided into general information, activities carried out during the pandemic and specific questions on the features of bss. many questions were the same for the two types of participants, while some differed in relation to the respective organizational and design skills of the users. Results: 102 healthcare professionals and 56 designers took part to the survey. the data analysis permitted to highlight a series of specific inputs that the bs project should take in consideration, such as: a) proximity to the emergency department (ed), intensive care (icu) and inpatient wards (iws); b) location within the hospital but separate from other medical areas; c) independent access; d) organizational and spatial features similar to ed, icu and iws; e) configuration of an operational space ready for whatever type of need; f) the bs should host approximately 12% of the ed stations (40 sqm/per station). Conclusions: The research aims to become a starting milestone for future investigations: in fact it is necessary to carry out a widespread analysis at the international level. Although the research was focused in hospital settings, the covid-19 pandemic referred also to the territorial healthcare facilities and therefore some considerations on that issue need to be improved