Health care-acquired aspergillosis and air conditioning systems

Review No Summar

Return visits to the Paediatric Emergency Department: first analysis in Italy

Return visits to the emergency room have come under scrutiny with a view to identifying the reasons for these events. The aim of the study was to estimate the incidence of return visits to emer- gency room and to compare this with data from other countries, with a view to proposing a method of monitoring this parameter nationwide. Ours is the first Italian study to report the incidence of return visits to the ER and to analyse the factors correlated with this phenomenon. The incidence of return visits within 72 hours of the first visit proved to be 2.5%. Statistical analysis revealed a significant difference in the number of return visits between patients under 1 year of age and those older than 1 year. Our future objective is to re-analyse recent case-records on the basis of the indicators identified, with a view to assessing the quality of the service

Assessment of the Triage System in a Pediatric Emergency Department. A pilot study on critical code

Introduction. In Italy, triage involves assigning a priority color code to patients arriving at the hospital Emergency Department: red (very critical), yellow (moderately critical), green (not very critical), and white (not critical). Methods. This study was aimed at assessing the triage system in the Emergency Department of ?Giannina Gaslini? Children? s Hospital in Genoa, Italy. The authors examined 130 triage forms assigning a yellow code in 2003, in order to determine whether they had been correctly filled in with regard to the detection of vital parameters, identification of main symptoms and color code assignment. Results. Results showed that vital signs were recorded in 94% of patients, main symptoms were identified in 97%, and a yel- low code was assigned according to hospital guidelines in 84%. The percentage of underestimation (3.2%) was higher than that reported in the literature (2%). Conclusions. The study shows the need to improve compliance with the guidelines and to evaluate green and white codes

Evaluation of Microbiological and Free-Living Protozoa Contamination in Dental Unit Waterlines

Studies conducted over the last 40 years have demonstrated that the water output from dental unit waterlines (DUWLs) is often contaminated with high densities of microorganisms. It has been monitored the microbiological quality of the water in 30 public dental facilities in northern Italy in order to assess the health risk for patients and dental staff. In each facility, samples of water both from taps and from DUWLs were analyzed in order to evaluate heterotrophic plate counts (HPCs) at 22 \ub0C and 36 \ub0C, and to detect coliform bacteria, Pseudomonas aeruginosa, Legionella pneumophila and amoebae. In 100% of the samples taken from the DUWLs, the concentration of HPCs was above the threshold as determined by the Minist\ue8re de la Sant\ue9 et des Solidarit\ue9s (2007). The concentration of P. aeruginosa was greater than the indicated threshold in 16.67% of the hand-pieces analyzed. A total of 78.33% of samples were contaminated by L. pneumophila, while in the samples taken from the DUWLs alone, this percentage rose to 86.67%. Amoebae were detected in 60% of the samples taken from hand-pieces; all belonging to the species V. vermiformis. This study documented the presence of various microorganisms, including Legionella spp., at considerably higher concentrations in water samples from DUWLs than in samples of tap water in the same facilities, confirming the role of the internal DUWLs in increasing microbial contamination, especially in the absence of proper management of waterborne health risks

The management of healthcare-related infections through lean methodology: systematic review and meta-analysis of observational studies.

Introduction: Lean is largely applied to the health sector and on the healthcare-associated infections (HAI). However, a few results on the improvement of the outcome have been reported in literature. The purpose of this study is to analyze if the lean application can reduce the HAI rate. Methods: A comprehensive search was performed on PubMed/Medline, Scopus, CINAHL, Cochrane, Embase, and Google Scholar databases using various combinations of the following keywords: "lean" and "infection". Inclusion criteria were: 1) research articles with quantitative data and relevant information on lean methodology and its impact on healthcare infections; 2) prospective studies. The risk of bias and the study quality was independently assessed by two researchers using the “The National Institutes of Health (NIH) quality assessment tool for before-after (Pre-Post) study with no control group”. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines has been used. 22 studies were included in the present meta-analysis. Results: Lean application demonstrated a significant protective role on healthcare-associated infections rate (RR 0.50 [0.38-0.66]) with significant impact on central line-associated bloodstream infections (CLABSIs) (RR 0.47 [0.28-0.82]). Conclusions: Lean has a positive impact on the decreasing of HAIs and on the improvement of compliance and satisfaction of the staff

Reducción de los descartes en la pesca con trasmallo: resultados experimentales utilizando trasmallo con “faldón” en la pesca artesanal del camarón, Penaeus kerathurus, en el mar Ligur (Mediterráneo Occidental)

This study aimed to test the effectiveness of a “guarding net”, a device placed at the bottom of a trammel net, for reducing unwanted catches in the caramote prawn trammel net fishery of the Ligurian Sea. This specialized and profitable fishery is affected by unwanted catches that generate high discard rates and damage to the nets, with environmental impacts and costs for fishermen. The experimental study consisted in comparing the catches of a standard trammel net (STN) with those of two “experimental” trammel nets, e.g. STNs provided with a guarding net of 19 cm (TGN20) and 24 cm height (TGN25), respectively. The guarding net, a strip of gillnet placed at the bottom of the net, can be considered a by-catch reducer device (BRD). Some fishermen of the investigated fishery have been using this device for several years. The results of the 15 experimental fishing trials performed from June to July 2016 indicate that the guarding nets significantly reduce discards (e.g. crabs and other invertebrates); the biomass of the unwanted species caught was 75% lower than that produced by the STN. The catch rates of the target species obtained with TGN20 and TGN25 were also significantly lower than those of the STN, though of a lesser amount. Nonetheless, this economic loss can be compensated by the decrease in sorting time and material and labour costs that can be achieved using the guarding net.El objetivo de este trabajo fue testar los efectos de un “faldón”, una red colocada en la parte inferior de un trasmallo, para reducir los descartes en la pesquería del camarón del mar Ligur. Se trata de una pesquería especializada y rentable, afectada por capturas no deseadas, que generan descartes y daños a las redes, con impacto ambiental y costes para los pescadores. Se llevaron a cabo pescas experimentales, para comparar la captura de un trasmallo estándar (STN) con la de dos trasmallos “experimentales”, construidos a partir de un trasmallo estándar, con el ajuste de un faldón de 19 cm de altura (TGN20), y de un faldón de 24 cm (TGN25). Este faldón, una banda de red de enmalle, se puede considerar como un dispositivo reductor de capturas accesorias (BRD). Algunos pescadores de la pesquería investigada ya utilizan este dispositivo desde hace algunos años. Los resultados de las quince pruebas experimentales, realizadas de junio a julio 2016, muestran que el faldón de red de enmalle contribuye significativamente a reducir los descartes (cangrejos y otros invertebrados), con una reducción de la biomasa de las especies descartadas hasta el 75%, respecto al trasmallo estándar. Al mismo tiempo, también las tasas de captura de las especies objetivo obtenidas con TGN20 y TGN25 fueron significativamente más bajas que las del STN, aunque de menor magnitud. Sin embargo, esta pérdida económica puede ser compensada por la disminución del tiempo de trabajo, de los costes del material y de la mano de obra, que se pueden lograr utilizando un trasmallo con “faldón”

A Clostridium difficile outbreak in an Italian hospital: the efficacy of the multi-disciplinary and multifaceted approach

Introduction: We described an outbreak of C. difficile that occurred in the Internal Medicine department of an Italian hospital and assessed the efficacy of the measures adopted to manage the outbreak.Methods: The outbreak involved 15 patients and was identified by means of continuous integrated microbiological surveillance, starting with laboratory data (alert organism surveillance).Diarrheal fecal samples from patients with suspected infection by C. difficile underwent rapid membrane immuno-enzymatic testing, which detects both the presence of the glutamate dehydrogenase antigen and the presence of the A and B toxins.Extensive microbiological sampling was carried out both before and after sanitation of the environment, in order to assess the efficacy of the sanitation procedure.Results: The outbreak lasted one and a half month, during which time the Committee for the Prevention of Hospital Infections ordered the implementation of multiple interventions, which enabled the outbreak to be controlled and the occurrence of new cases to be progressively prevented.The strategies adopted mainly involved patient isolation, reinforcement of proper hand hygiene techniques, antimicrobial stewardship and environmental decontamination by means of chlorine-based products. Moreover, the multifaceted management of the outbreak involved numerous sessions of instruction/training for nursing staff and socio-sanitary operatives during the outbreak.Sampling of environmental surfaces enabled two sites contaminated by C. difficile to be identified.Conclusions: Joint planning of multiple infection control practices, together with effective communication and collaboration between the Hospital Infections Committee and the ward involved proved to be successful in controlling the outbreak

Epidemiology, management, and outcome of carbapenem-resistant Klebsiella pneumoniae bloodstream infections in hospitals within the same endemic metropolitan area

In the last decade, carbapenem-resistant Klebsiella pneumoniae (CR-Kp) has become endemic in several countries, including Italy. In the present study, we assessed the differences in epidemiology, management, and mortality of CR-Kp bloodstream infection (BSI) in the three main adult acute-care hospitals of the metropolitan area of Genoa, Italy.From January 2013 to December 2014, all patients with CR-Kp BSI were identified through the computerized microbiology laboratory databases of the three hospitals. The primary endpoints of the study were incidence and characteristics of CR-Kp BSI in hospitals within the same endemic metropolitan area. Secondary endpoints were characteristics of CR-Kp BSI in hospitals with and without internal infectious diseases consultants (IDCs) and 15-day mortality.During the study period, the incidence of healthcare-associated CR-Kp BSI in the entire study population was 1.35 episodes per 10,000 patient-days, with substantial differences between the three hospitals. Patients admitted to the two hospital with internal IDCs were more likely to receive post-susceptibility test combined therapy including carbapenems (77% vs. 26%, p <. 0.001), adequate post-susceptibility test therapies (86% vs. 52%, p <. 0.001), and post-susceptibility therapies prescribed by an infectious diseases specialist (84% vs. 14%, p <. 0.001). Overall, the crude 15-days mortality was 26%. In the final multivariable model, only septic shock at BSI presentation was unfavorably and independently associated with 15-days mortality (odds ratio [OR] 6.7, 95% confidence intervals [CI] 2.6-17.6, p <. 0.001), while a protective effect was observed for post-susceptibility test combined therapies including a carbapenem (OR 0.11, 95% CI 0.03-0.43, p = 0.002).Mortality of CR-Kp remains high. Differences in the incidence of CR-Kp BSI were detected between acute-care centers within the same endemic metropolitan area. Efforts should be made to improve the collaboration and coordination between centers, to prevent further diffusion of CR-Kp

Quality in Emergency Departments: a study on 3,285,440 admissions

INTRODUCTION: A multi-centre study has been conducted, during 2005, by means of a questionnaire posted on the Italian Society of Emergency Medicine (SIMEU) web page. Our intention was to carry out an organisational and functional analysis of Italian Emergency Departments (ED) in order to pick out some macro-indicators of the activities performed. Participation was good, in that 69 ED (3,285,440 admissions to emergency services) responded to the questionnaire. METHODS: The study was based on 18 questions: 3 regarding the personnel of the ED, 2 regarding organisational and functional aspects, 5 on the activity of the ED, 7 on triage and 1 on the assessment of the quality perceived by the users of the ED. RESULTS AND CONCLUSION: The replies revealed that 91.30% of the ED were equipped with data-processing software, which, in 96.83% of cases, tracked the entire itinerary of the patient. About 48,000 patients/year used the ED: 76.72% were discharged and 18.31% were hospitalised. Observation Units were active in 81.16% of the ED examined. Triage programmes were in place in 92.75% of ED: in 75.81% of these, triage was performed throughout the entire itinerary of the patient; in 16.13% it was performed only symptom-based, and in 8.06% only on-call. Of the patients arriving at the ED, 24.19% were assigned a non-urgent triage code, 60.01% a urgent code, 14.30% a emergent code and 1.49% a life-threatening code. Waiting times were: 52.39 min for non-urgent patients, 40.26 min for urgent, 12.08 for emergent, and 1.19 for life-threatening patients

A Systematic Review and International Web-Based Survey of Randomized Controlled Trials in the Perioperative and Critical Care Setting: Interventions Reducing Mortality

The authors aimed to identify interventions documented by randomized controlled trials (RCTs) that reduce mortality in adult critically ill and perioperative patients, followed by a survey of clinicians’ opinions and routine practices to understand the clinicians’ response to such evidence. The authors performed a comprehensive literature review to identify all topics reported to reduce mortality in perioperative and critical care settings according to at least 2 RCTs or to a multicenter RCT or to a single-center RCT plus guidelines. The authors generated position statements that were voted on online by physicians worldwide for agreement, use, and willingness to include in international guidelines. From 262 RCT manuscripts reporting mortality differences in the perioperative and critically ill settings, the authors selected 27 drugs, techniques, and strategies (66 RCTs, most frequently published by the New England Journal of Medicine [13 papers], Lancet [7], and Journal of the American Medical Association [5]) with an agreement ≥67% from over 250 physicians (46 countries). Noninvasive ventilation was the intervention supported by the largest number of RCTs (n = 13). The concordance between agreement and use (a positive answer both to “do you agree” and “do you use”) showed differences between Western and other countries and between anesthesiologists and intensive care unit physicians. The authors identified 27 clinical interventions with randomized evidence of survival benefit and strong clinician support in support of their potential life-saving properties in perioperative and critically ill patients with noninvasive ventilation having the highest level of support. However, clinician views appear affected by specialty and geographical location