Hospital discharge diagnoses in patientswith positive blood cultures in an Italian academic hospital

Objective. To assess the sensitivity of hospital discharge diagnoses for identifying sepsis in patients with blood culture confirmation.Methods. A cross-sectional study was conducted at the Italian 1000-bed University Hospital of Udine. The administrative databases of the Hospital were used as the source of information. Laboratory data were linked with hospital discharge data. We estimated the proportion of hospitalizations with at least 2 positive blood culture tests in which at least one discharge diagnosis indicated bloodstream infection.Results. From 2011 to 2017, 3571 hospitalizations (1.2%) had positive blood culture tests. Of them, only 49.5% had at least one ICD-9-CM discharge diagnosis code of sepsis, with lower proportions in surgical than in medical wards.Conclusions. The sensitivity of ICD-9-CM discharge codes for sepsis is low as compared with the blood culture gold standard. Using discharge codes for epidemiological estimates of sepsis, health planning and risk management may yield biased results. Audits and ICD coding training are needed

A look at the past to draw lessons for the future: how the case of an urgent ICU transfer taught us to always be ready with a plan B

Objective: The urgent transfer of an intensive care unit (ICU) is particularly challenging because it carries a high clinical and infectious risk and is a critical node in a hospital’s patient flow. In early 2017, exceptional rainfall damaged the roof of the tertiary hospital in Udine, necessitating the relocation of one of the three ICUs for six months. We decided to assess the impact of this transfer on quality of care and patient safety using a set of indicators, primarily considering the incidence of healthcare-associated infections (HAIs) and mortality rates. Methods: We performed a retrospective, observational analysis of structural, process, and outcome indicators comparing the pre- and posttransfer phases. Specifically, we analyzed data between July 2016 and June 2017 for the transferred ICU and examined mortality and the incidence of HAI. Results: Despite significant changes in structural and organizational aspects of the unit, no differences in mortality rates or cumulative incidence of HAIs were observed before/after transfer. We collected data for all 393 patients (133 women, 260 men) admitted to the ICU before (49.4%) and after transfer (50.6%). The mortality rate for 100 days in the ICU was 1.90 (34/1791) before and 2.88 (37/1258) after transfer (p = 0.063). The evaluation of the occurrence of at least one HAI included 304 patients (102 women and 202 men), as 89 of them were excluded due to a length of stay in the ICU of less than 48 h; again, there was no statistical difference between the two cumulative incidences (13.1% vs. 6.9%, p = 0.075). Conclusion: In the case studied, no adverse effects on patient outcomes were observed after urgent transfer of the injured ICU. The indicators used in this study may be an initial suggestion for further discussion

Health professionals who have worked in COVID-19 immunization centers suffer the effects of violence

BackgroundThe phenomenon violence against health professionals has received increasing attention in recent years because of its frequency and significant impact on victims’ mental health and disruption of health services. Despite this attention, little is known about the incidence of workplace violence in the highly politicized immunization services. Therefore, we decided to examine the prevalence of workplace violence in the COVID-19 immunization campaign, the risk and protective factors, and the impact on victims’ mental health.MethodsBetween March and April 2022, we conducted an anonymous online survey among health professionals working in COVID-19 vaccination centers in the Friuli-Venezia Giulia Region (Italy). We used the Questionnaire for Workplace Violence in Healthcare Settings and the Impact of Event Scale–Revised.ResultsOf the 200 participants, 93 (46.5%) reported being victims of an act of violence during the vaccination campaign, 60 of them verbally and 7 physically. In 35.5% of cases, the IES score indicated a possible post-traumatic stress reaction in the victim. Opinions on measures to prevent violence and support workers in the workplace differed according to the sex of the health professional, with women emphasizing the need for self-defense training and improvement of security arrangements (p < 0.001).ConclusionOne-third of health professionals involved in the COVID-19 immunization campaign reported that their mental health was affected by workplace violence. Public health professionals dealing with politicized and debated issues such as immunization should receive more attention, as should the implementation of a more structured and multidisciplinary approach to the problem within healthcare organizations

A Wide Range of Strategies to Cope with Healthcare Workers’ Vaccine Hesitancy in A North-Eastern Italian Region: Are They Enough?

The recent pandemic reminded the world of the high risk of healthcare workers (HCWs) and patient contagiousness along with the healthcare services disruption related to nosocomial outbreaks. This study aims at describing vaccination campaigns within healthcare institutions of a North-Italian Region and comparing their effectiveness in term of vaccination coverage. In December 2019, we surveyed all healthcare institutions of Friuli Venezia Giulia Region throughout an email questionnaire with 15 questions investigating strategies adopted for the vaccination of HCWs against influenza and other vaccine-preventable diseases (VPDs), along with actions put in place in case of a VPD exposure. We found a strong heterogeneity in VPDs prevention and control policy and practice for HCWs, along with responsibility attribution ranging among different stakeholders. Strategies adopted to promote vaccination included a wide range of methods, but HCWs’ influenza vaccination coverage still ranged from 17.0 to 33.3%. Contact tracing after a VPD exposure did not always include medical residents and students and visitors/caregivers/extra personnel as possible contacts. Even if knowledge and complacency gaps among HCWs could be faced with education activities, more efforts should be done in identifying and implementing effective vaccination strategies, and mandatory vaccination for HCWs could be introduced to achieve host, herd, and healthcare immunity preventing possible hospital outbreaks

Utilizzo delle prevalenze ripetute per la sorveglianza delle Infezioni nelle Organizzazioni Sanitarie (IOS): l\u2019esperienza del Friuli Venezia Giulia.

Obiettivi. Tra i programmi del governo clinico per la sicurezza del paziente della regione Friuli Venezia Giulia quello riguardante il controllo e la prevenzione delle infezioni ricopre un ruolo molto importante; in questo contesto una sorveglianza puntuale sulle Infezioni nelle Organizzazioni Sanitarie (IOS) e sull\u2019utilizzo degli antibiotici (UA) estesa a livello regionale riveste un ruolo fondamentale per stimarne dimensioni e caratteristiche in modo da identificare le priorit\ue0 e attuare azioni di miglioramento condivise. Metodi. Sono state eseguite due Point Prevalence Survey (PPS), la prima nell\u2019ottobre 2011 e la seconda nell\u2019ottobre 2013. Le rilevazioni hanno coinvolto tutte le strutture per acuti della regione sia pubbliche che private accreditate. In entrambe le rilevazioni \ue8 stato utilizzato il protocollo sviluppato per la PPS promossa dall\u2019ECDC nel 2011. Prima di ogni PPS sono state organizzate due giornate formative sull\u2019utilizzo del protocollo ECDC che hanno contribuito a formare circa 140 professionisti sanitari. Risultati. Nel 2011 i pazienti inclusi sono stati 3267 con una prevalenza di IOS del 6,9% e di UA del 40,7%, nel 2013 i pazienti inclusi sono stati 3360 con una prevalenza di IOS del 6,2% e di UA del 39%. Nel 2011 su un totale di 248 IOS le pi\uf9 frequenti sono state le infezioni delle vie urinarie (IVU) 62, le polmoniti 49 e le infezioni del sito chirurgico 42, nel 2013 su 223 IOS le pi\uf9 frequenti sono state le polmoniti 56, le IVU 54 e le sepsi 32. Discussione. L\u2019utilizzo ripetuto delle PPS consente di valutare, a livello regionale l\u2019impatto dei programmi in essere e di individuare le possibili aree di miglioramento, a livello delle singole aziende fornisce un valido strumento per il benchmark

Use of repeated point prevalence surveys for the prevention and control of healthcare associated infections and antimicrobial use: an Italian region experience

Background. Friuli Venezia Giulia (FVG) has a regional patient safety programme that involves all the public and private healthcare facilities. In this context infection control is one of the most important topics in particular the prevention and control of Healthcare Associated Infections (HAI) together with the management of antimicrobials. Aim. The aim of our study was to collect data to evaluate the effectiveness of FVG infection control programmes and to set up the future steps. Methods. In October 2011 all acute hospital of FVG participated to the ECDC European point prevalence survey (PPS) of HAI and antimicrobial use (AU). In October 2013 the PPS was repeated according to the ECDC protocol. Results. Included patients were 3267 (2011) and 3360 (2013). HAI prevalence was 6.9% (2011) and 6.2% (2013), while AU was 40.7% (2011) and 39.0% (2013). Most important results were the decrease in 2013 of surgical site infection in the third level hospitals (19/1878) versus 2011 (37/1902) (OR 0.52 IC95% 0.30-0.90), the increase of pneumonia in 2013 in the first and second level hospitals (24/1105) versus 2011 (10/1023) (OR 2.22 IC95% 1.07-4.62) and the increase of one shot and less than 24 hours procedures for the surgical prophylaxis in 2013 (182/284) versus 2011 (181/322) (OR 1.39 IC95% 1.00-1.93). Discussion.The repeated use of ECDC PPS can be a very useful tool to provide valuable data, both to single healthcare facility and regional government, to evaluate the quality of care provided to patients and the impact of the implemented programmes. Making public these data can fulfil the 24/2011/EU directive

Evaluation of the available apps to support the Italian physicians in the Antimicrobial Stewardship implementation

Background and Objective: Antimicrobial resistance (AMR) is a serious problem and remains one of the greatest global threats to public health at the beginning of the 21st century. As digital technologies become an important resource for healthcare delivery and public health, we decided to investigate the available apps to support Italian physicians combat AMR. Methods: A systematic research was performed by four independent researchers in the Apple and Google Play App stores using English and Italian keywords. After excluding content in languages other than Italian or English, gaming, photo and video, paid apps and contents, and advertisement, apps were downloaded and analysed using an 86-item checklist including pathogens/etiological agents, support for diagnosis and therapy, AMR, dashboard function, antimicrobial stewardship (AMS), notes and recordings, network, technical characteristics of app domains as validated by experts. Results: Of the 115 apps initially identified, 27 (6 for Android, 21 for iOS, 1 for both) were analyzed. No app met all desirable aspects; only one met 36% of the criteria. From highest to lowest scores, domains are support for diagnosis and therapy (37%), technical characteristics of the app (22%), AMS (8%), pathogens/ etiological agents (4%), notes and recordings (3%), network (2%), AMR (1%) and dashboard function (1%). Most apps support identification of the drug for targeted therapy against a specific microorganism (78%) and the ability to be used offline (81%). Conclusions: No available app was able to adequately provide the desired features. To engage all prescribing physicians in the fight against AMR and implement AMS, an app that meets all requirements must be developed

Promotion of flu vaccination among healthcare workers in an Italian academic hospital: an experience with tailored web tools

Background: Influenza causes significant mortality particularly among the elderly and high-risk groups. Healthcare workers (HCWs) are at risk of occupational exposure due to contact with patients. Aims of this study was to promote flu shot among HCWs through a multimedia campaign in a large North-Eastern Italian Hospital. Methods: The 2013/2014 flu vaccination multimedia campaign addressed to HCWs was developed by maintaining pre-existing tools (letters in pay slip and poster displayed in wards) and creating 4 on-line spots (30") delivered trough the hospital intranet. Campaign effectiveness was assessed in terms of changes in knowledge, attitude and practice comparing data of pre (10 items) and post test (20 items) survey on a randomized sample of HCWs. Results: Response rates were 92.6% (464/501) in pre-test and 83.2% (417/501) in post-test. 93.8% (391/417) of HCWs reported to awareness of the campaign to promote vaccination. Spots were seen by 59.6% (233/391) of HCWs. Some reasons for vaccine denial, \u201cnot believing in vaccine efficacy\u201d (34.7% to 14.9%), \u201cnot considering flu as a serious problem\u201d (from 24% to 12.6%), \u201cthinking not to get sick\u201d (28.7% to 18.2%) or \u201cbeing against the vaccine\u201d (32.7% to 21%), showed a statistically significant reduction after the exposure to the campaign. The \u201cintention to get vaccinated in the next year\u201d instead, raised effectively (13.1% to 36.6%). Vaccinated HCWs rate in 2013-2014 season was 7.6% (221/2910), and 5.6% (164/2910) in 2012-2013 (p<0.005). Conclusions: The multimedia campaign succeeded with regard to KAP outcomes, but the vaccination rate is still far from the goal of 90%. Due to their impact, especially on younger age groups, web tools deserve to be better studied as effective approach to convey health information among HCW

Neuroinvasive West Nile Infection with an Unusual Clinical Presentation: A Single-Center Case Series

The 2018 West Nile Virus (WNV) season in Europe was characterized by an extremely high infection rate and an exceptionally higher burden when compared to previous seasons. Overall, there was a 10.9-fold increase in incidence in Italy, with 577 human cases, 230 WNV neuroinvasive diseases (WNNV) and 42 WNV-attributed deaths. Methods: in this paper we retrospectively reported the neurological presentation of 7 patients admitted to University Hospital of Udine with a diagnosis of WNNV, especially focusing on two patients who presented with atypical severe brain stem involvement. Conclusions: the atypical features of some of these forms highlight the necessity to stay vigilant and suspect the diagnosis when confronted with neurological symptoms. We strongly encourage clinicians to consider WNNV in patients presenting with unexplained neurological symptoms in mild climate-areas at risk

How parents and health professionals experience prematurity in an Italian neonatal intensive care: A grounded theory study

The aim of this study was to explore prematurity as a psycho-social process from the point of view of both parents and healthcare professionals