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Background Multidrug-resistant organisms (MDRO) are one of the most critical public health concerns, particularly in hospital settings. Nearly 8% of hospitalized patients develop healthcare-associated infections (HAI), 20% of which is caused by MDRO. Aim of the study was to estimate nosocomial infection-associated in-hospital mortality, by different MDRO, in a large Italian teaching hospital. Methods We conducted a retrospective cohort study on patients hospitalized at San Raffaele Hospital, Milan, from 2016 to 2018. Two existing datasets were merged: hospital discharge records and MDRO surveillance data. Exposure was defined as any HAI caused by MDRO, and main outcome variable was in-hospital mortality from all causes. Results A total of 78,795 patients were studied (mean age 59.3 y, age range 18-105 y). 1,345 patients with at least one MDRO had mean age of 68 y, mean length of stay (LOS) of 32.8 days and mean DRG weight of 3.8. 77,450 patients without MDRO isolation had mean age of 59 y, mean LOS of 7.2 days and mean DRG weight of 1.6. Risk of in-hospital mortality is 3.4 times higher in patients with at least one MDRO isolation (OR 3.4; 95% CI 2.8-4.2). Enterococci (OR 2.6; 95% CI 1.1-6.3), A. baumannii (OR 3.5; 95% CI 1.4-8.6), P. aeruginosa (OR 1.8; 95% CI 0.8-4.2), MRSA (OR 3.4; 95% CI 2.1-5.4), ESBL-producing (OR 1.9; 95% CI 1.4-2.7) and carbapenem-resistant bacteria (OR 3.8; 95% CI 2.5-5.7), and carbapenem-resistant K. pneumoniae (OR 5.5; 95% CI 3.2-9.2) isolations were risk factors for nosocomial mortality. Conclusions Patients with MDRO isolations were older, more complex and had 5 times longer LOS than ones without MDRO. Deceased patients were 18% among MDRO cohort against only 2% among others. Bacteria included in WHO list of priority pathogens with antibiotic resistance were associated with a significantly higher risk of death. These results prove the urgency of controlling MDROs' spread that threatens global public health and available treatments of infections. Key messages Nosocomial MDRO isolation is a significant risk factor for in-hospital mortality from all causes. Infection prevention and control measures, and antibiotic stewardship are key strategies in order to prevent MDRO transmission and HAI, AR spreading and their burden of related deaths.

Issue Filling out medical records properly in Emergency Departments (ED) can be challenging, due to the high number of daily admissions and the variety of involved health care professionals (HCP). Description of the Problem The ED of IRCCS San Raffaele Hospital (OSR), with a mean of 198 admissions per day in 2019, suffers of frequent overcrowding; patients are managed by multiple HCPs, based on specific care needs; coordination and handover between them are crucial to guarantee quality care. The OSR Healthcare Directorate, the ED's Staff and the School of Public Health of Vita-Salute San Raffaele University developed and validated a model of internal audit to identify ED medical records' quality issues and to implement corrective actions. The workflow included: developing a structured checklist, mapping critical processes and highlighting each figure's tasks. A group of auditors, made up by medical residents in Public Health, tested n = 300 medical charts, filled out during the first semester of 2019, picked up in order to provide a representative sample of the triage priority codes assigned to patients in this period. Results To assess completeness and quality of ED's medical records, a new checklist was developed, comprising 4 major sections, furtherly divided in 14 items, scored from 1 (poor adherence/completeness) to 5 (excellent), providing a total score for each record, ranging from 14 to 70. Specific comments to items could be added and an ultimate judgement was written by each auditor. This approach made medical records measurable and comparable. Lessons The new checklist and the audit process are useful instruments for the evaluation of medical records and the identification of corrective measures in the ED of our hospital. Next steps will be the extension of the sample, the implementation of corrective actions, and the institution of a stable working group for a regular evaluation. Key messages ED's medical records must be clear, understandable and complete. The developed checklist is a tool for preventing and correcting wrong behaviours in a continuous improvement perspective.

Aim Due to the improving of life conditions, life expectancy is steadily increasing, especially in developed countries. In this perspective, Governments have to face important challenges as guaranteeing the welfare state, providing pensions and long-term healthcare for an increasing number of people. To maintain the sustainability of the pension system, many developed countries are rising the proportion of elderly persons in paid employment by both extending working life through a higher official retirement age and preventing premature exit from paid employment. However, postponing the exit from work exposes workers to potential stressors for a longer period. Stress is one of the risk factors for depression, that represent one of the leading causes of burden of disease. Our aim is to retrieve evidence in order to understand the association between retirement and risk of depression. Methods This is a systematic literature review, conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In January 2020, the following databases PubMed/Medline, Embase, Psycoinfo, and Cochrane were used to perform the search, using a combination of three components of keywords: depression, aging and retirement. Results A total of 2,203 studies were retrieved of which 782 were excluded because duplicates. Screening of 1,421 retrieved studies is in progress and data will be showed in tables and summarized in narrative form. Results are preliminary. Conclusions The present research intends to bridge the lack of knowledge on the association between retirement and depression, to tackle these methodological limitations of the evidence, and to contribute to the advancement of scientific knowledge on the link between work life extension and mental health. Poor mental health is a major source of disability. Improving mental health of workers remains a critical goal if future populations need to reach older age in good health and continue to work. Key messages Work life has been extended but low information are available regarding its impact on depression. Depression is a leading cause of burden of disease and studies aimed to reduce its incidence are extremely needed.

Background During infectious disease emergencies, fully aware healthcare workers (HCWs) and public services staff are unique resources to keep health systems active and tackle epidemics. Aim of the study was to assess concern, general and health-related knowledge (case management and Infection Prevention and Control [IPC] measures) among hospital staff on SARS-CoV-2 in Lombardy region (Italy). Methods One week after WHO declared COVID-19 a public health emergency we developed and online administered a 7-item questionnaire to all staff of San Raffaele Hospital, a referral and teaching hospital in Milan, exploring knowledge and attitudes on COVID-19. The survey remained accessible online for 72 hours. Results A total of 2,046, including HCWs and other staff, answered the survey (response rate 25%). Among the 2,027 responders included in the analysis, 1,102 were HCWs (54%), also in training, and 924 non-HCWs (46%). 60% of responders reported being worried or extremely worried about the epidemic. Concerning knowledge, the survey asked about modes of transmission, clinical forms, preventive measures in everyday life in Italy and cough etiquette. There were uniform trends in the two groups: HCWs were more aware and answered more properly (mean of correct answers 71,6%) than non-HCWs (mean 61,2%). HCWs were asked about IPC precautions, with only 41% providing correct answers, while over 74% knew only supportive therapy is currently available against COVID-19. Conclusions We were among the first to explore hospital staff knowledge on COVID-19 reporting data from a large study population. HCWs were slightly less concerned but more knowledgeable than general staff. Last questions showed that among HCWs there is generally good knowledge on the topic. However, most of the responders missed the recommendations to adopt simultaneously standard, contact and airborne precautions plus eye protection managing suspected and confirmed cases, as proposed by national and international authorities. Key messages During the ongoing emergency, it is of utmost importance that hospital staff is adequately trained to implement the best IPC measures and limit the spread of the infection. Our data can inform planning of these preventive measures.

Population ageing presents both challenges and opportunities for societies around the world. Increasing statutory retirement age and limiting exits to early retirement are frequent policy responses to population ageing, but this is unlikely to have the desired impact if the complex relationships that link work, retirement and health remains unknown. In this context, we designed and are currently conducting the multi-partner project on pension reforms and spatial-temporal patterns in healthy ageing, funded by Fondazione Cariplo. The project involves a multi-disciplinary research team from University Vita-Salute San Raffaele, Bocconi University and the Unit of Epidemiology of the Regional Health Service of ASL TO3. In this first presentation we will first describe the project design, its general aim and specific objectives, then we will present a proposed conceptual framework on the association between retirement and health and its determinants. The framework is the first deliverable of the project and is the results of a comprehensive review of the available evidence and consultation with experts in the field. In particular we conducted a scoping review to retrieve, pool and critically appraise the relevant evidence on the impact of retirement and transition to retirement on physical and mental health and their determinants. We summarized the evidence collected in a conceptual framework that attempt to quantify how health and retirement are bi-directionally linked, how health is central to the timing of retirement, how labor-associated determinants condition employment cessation, how and retirement have varying effects on risk factors for physical and mental health and the role of confounding factors and mediators. Towards the end of the presentation we will outline an extensive stakeholder mapping carried out for the purposes of the project at the national and European level

Background Advances in the field of Information and Communication Technology (ICT) are revolutionizing healthcare, while massive migration flows and cross-border populations’ transit impose the planning, implementation, and evaluation of new integrated healthcare services and programmes. Nevertheless, no conclusive evidence exists on the vast potential offered by ICT to promote healthcare in migrant populations. Methods We carried out a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to retrieve, pool and critically appraise all the available evidence on the effectiveness of ICT-based interventions to support the healthcare provision to migrant and in-transit populations in Europe. We searched the electronic databases Medline and Embase, relevant grey literature and consulted with experts in the field. We restricted the area of interest to EU/EEA countries and included studies providing original quantitative data. Results Out of 127 retrieved records, 53 (42%) met the inclusion criteria. Included studies were classified in the following four interventions: implementation of healthcare services (47%), patients’ education (26%), healthcare services’ monitoring (17%), and interventions on providers (10%). The most relevant data refer to telemedicine, prevention interventions, and healthcare data sharing and the most represented specific health-topic is that of mental health (26%). We present available data qualitatively and quantitatively pooled by country, type of ICT, target population and health topic. Conclusions Selected ICT-based interventions have been implemented in Europe to promote healthcare in migrant populations; however, in most cases, no monitoring and evaluation exist on their impact, effectiveness, and cost-effectiveness. Strengthened efforts are needed to identify, plan, implement and evaluate effective interventions and share best practices to protect in-transit populations’ health. Key messages Information and Communication Technology (ICT) offer great potential to promote health-care in migrant populations. Effective ICT interventions and best practices should be shared across Europe.