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ObjectivesAccidental falls are among the leading hospitals' adverse events, with incidence ranging from 2 to 20 events per 1.000 days/patients. The objective of this study is to assess the relationship between in-hospital falls and the score of 3 DEPendence and Clinical-Social Fragility indexes.MethodsA monocentric case-control study was conducted by retrieving data of in-hospital patients from the electronic health records.ResultsSignificant differences between the mean scores at the hospital admission and discharge were found. The BRASS scale mean (SD) values at the admission and at the discharge were also significantly higher in cases of in-hospital falls: at the admission 10.2 (+/- 7.7) in cases versus 7.0 (+/- 8.0) in controls (P = 0.003); at the discharge 10.0 (+/- 6.4) versus 6.7 (+/- 7.5) (P = 0.001). Barthel index mean (SD) scores also presented statistically significant differences: at the admission 60.3 (+/- 40.6) in cases versus 76.0 (+/- 34.8) in controls (P = 0.003); at discharge 51.3 (+/- 34.9) versus 73.3 (+/- 35.2) (P = 0.000).Odds ratios were as follows: for Barthel index 2.37 (95% CI, 1.28-4.39; P = 0.003); for Index of Caring Complexity 1.45 (95% CI, 0.72-2.91, P = 0. 255); for BRASS index 1.95 (95% CI, 1.03-3.70, P = 0.026). With BRASS index, the area under the curve was 0.667 (95% CI, 0.595-0.740), thus indicating a moderate predictive power of the scale.ResultsSignificant differences between the mean scores at the hospital admission and discharge were found. The BRASS scale mean (SD) values at the admission and at the discharge were also significantly higher in cases of in-hospital falls: at the admission 10.2 (+/- 7.7) in cases versus 7.0 (+/- 8.0) in controls (P = 0.003); at the discharge 10.0 (+/- 6.4) versus 6.7 (+/- 7.5) (P = 0.001). Barthel index mean (SD) scores also presented statistically significant differences: at the admission 60.3 (+/- 40.6) in cases versus 76.0 (+/- 34.8) in controls (P = 0.003); at discharge 51.3 (+/- 34.9) vers

L'evoluzione delle politiche vaccinali italiane mostra una crescente attenzione verso gli adulti e gli anziani, spostando parzialmente il focus dalle fasce pediatriche. Questo cambio riflette la demografia in trasformazione e il crescente tasso di cronicità e multicronicità tra la popolazione. Le malattie prevenibili tramite vaccino presentano rischi significativi per questi gruppi a causa di complicanze legate alle condizioni di salute preesistenti e alla immunosenescenza. L'ospedale, tipicamente luogo di cure specialistiche, emerge come sede cruciale per l'implementazione delle campagne vaccinali, sottolineando il suo ruolo essenziale nella prevenzione oltre alla cura delle acutezze.

L'ospedale, essenziale nella fornitura di cure specialistiche per pazienti acuti, varia in tipologie e gestione, includendo strutture pubbliche, private e accreditate. La categorizzazione comprende Presidi Ospedalieri, Aziende Ospedaliere, Policlinici Universitari, Aziende Ospedaliere miste, IRCCS, ospedali classificati e istituti privati accreditati. Questi centri devono garantire servizi essenziali come pronto soccorso, degenza, operatori, diagnostica, e farmacia, seguendo modelli organizzativi che favoriscono l'integrazione tra unità operative. Il Decreto Ministeriale 70/2015 enfatizza l'integrazione ospedale-comunità, proponendo una riorganizzazione per ottimizzare l'efficacia assistenziale e contenere i costi.

The COVID-19 vaccination campaign in Italy started in December 2020, and, due to the Omicron variant's emergence, a second booster dose was recommended for high-risk individuals and healthcare workers from July 2022. The aim of the study was to evaluate the vaccination coverages for the COVID-19 second booster dose and to identify predictors of its acceptance within the population of medical residents (MRs) of the Fondazione Policlinico Universitario "A. Gemelli" IRCCS (FPG) University Hospital. The study was conducted at FPG from October 4th to December 21st, 2022, and COVID-19 second booster dose and influenza vaccines were administered. The study analyzed collected data and conducted multivariate logistic regressions to explore potential predictors of vaccination adherence. The analyses performed were compared with the sample enrolled in FPG residency programs at the start of the COVID-19 vaccination campaign. 1968 MRs were involved in the 2022-2023 vaccination campaign (mean age 28.97, SD 3.44), and the second booster dose of COVID-19 vaccination coverage was low (18.80%). Almost all participants opted for co-administration of COVID-19 and influenza vaccinations, leading to a similar rate of influenza vaccination coverage (16.26%). Being a frontline resident, meaning a direct involvement in managing COVID-19 patients and vaccination campaigns, was the main predictor of vaccination adherence (OR 1.72, 95% CI 1.25-2.17). The dropping in influenza vaccination coverage in 2022-2023 and the low adherence to COVID-19 second booster dose among young physicians is concerning, calling for tailored vaccination campaigns and interventions.

Background: The role of the Mediterranean Diet (MD) in reducing cardiovascular (CV) risk is widely demonstrated and many studies have shown the effectiveness of educational interventions in primary prevention. This study aimed to evaluate the impact of a multidisciplinary educational intervention, that included nutritional, psychological and physical activity coaching, on adherence to MD and on CV risk. Methods: In a Roman neighborhood, general practitioners enrolled 41 subjects to take part in the educational intervention from November 2018 (T0) to November 2019 (T1). Participants' anthropometric measures, haematochemical parameters and CV risk score were assessed before and after the intervention. Furthermore, their adherence to MD was evaluated through the analysis of food frequency questionnaires using Medi-Lite. Results: The study found a significant reduction of 2.5 points in individual CV risk score, and an increase of 2.5 point in adherence to the MD. The stratification by gender showed statistically significant decreases in weight of 1.16 kg, BMI of 0.47, LDL cholesterol of 14.00 mg/dL, and individual CV risk score of 1.16 points among female participants. Conclusions: These results show that a multidisciplinary educational intervention model including the adoption of MD could be an effective strategy in Public Health for CV primary prevention and improvement of people's lifestyles.

The concurrent administration of COVID-19 and influenza vaccines has arisen as a promising approach to bolster protection against respiratory pathogens and improve vaccination rates. However, there remains a lack of data regarding the prevalence of co-administration across several vaccination campaigns, especially among healthcare workers (HCWs). Therefore, this study aims to shed light on the acceptance of co-administration strategies among HCWs during the two campaigns following the introduction of the anti-SARS-CoV-2 vaccine. A retrospective cohort study was conducted among the HCWs of the Fondazione Policlinico Universitario "A. Gemelli" IRCCS, a research hospital in Rome. Hospital administrative databases were accessed to gather information about vaccination for SARS-CoV-2 and influenza during the 2021/2022 and 2022/2023 vaccination campaigns. The study included 7399 HCWs. The co-administration of anti-SARS-CoV-2 and influenza vaccines presented a significant rise in 2022/2023 compared to the previous vaccination campaign (+38%): this was confirmed for every professional category, with the largest increases among resident doctors (+47%) and physicians (+44%), and also for every age category, but it was particularly evident for the youngest health professionals. The probability of co-administration uptake during the 2022/2023 campaign was significantly higher for males, and for those that received co-administration during the 2021/2022 campaign, while the probability was lower for nurses and administrative staff. This study highlights the co-administration procedure as a valuable and effective tool in annual vaccination campaigns for SARS-CoV-2 and influenza. The procedure's safety and streamlined logistics make it increasingly attractive for implementation, particularly among HCWs.

The COVID-19 pandemic is considered one of the deadliest pandemics in history. Pregnant women are more susceptible to developing serious diseases during COVID-19 than their non-pregnant peers. Pregnant women often express doubt about accepting the vaccination, especially in regard to their security and safety. This study aims to investigate the appreciation of the vaccination offer, and if there are any determinants impacting vaccine hesitancy. A questionnaire was administered to a sample of pregnant women who had just received their immunization against COVID-19 at the vaccination service of a teaching hospital in Rome, from October 2021 to March 2022. A high appreciation of the vaccination services was found, both for the logistic organization and the healthcare personnel, with mean scores above 4 out of 5. The degree of pre-vaccinal doubt was low (41%) or medium (48%) for the largest part of the sample, while the degree of COVID-19 vaccine knowledge was high for 91% of the participants. Physicians were the most decisive information source for the vaccination choice. Our results highlighted that a supportive approach could increase appreciation and improve the setting of vaccinations. Healthcare professionals should aim for a more comprehensive and integrated role of all figures.

Background and objective: The fourth dose the COVID-19 vaccine was first proposed to immunocompromised patients. The aim of the article is to systematically review the literature and report the humoral response and outcomes after the fourth dose administration in people with impaired immune system.Methods: Published studies on the humoral response, efficacy and safety of the fourth dose of the COVID-19 vaccine were analyzed in various settings of immunocompromised patients. We conducted systematic searches of PubMed, Cochrane Library and WHO COVID-19 Research Database for series published through January 31, 2023, using the search terms "fourth dose" or "second booster" or "4th dose" and "Coronavirus" or "COVID-19" or "SARS-CoV-2." All articles were selected according to the PRISMA guidelines.Results: A total of 24 articles including 2,838 patients were comprised in the systematic review. All the studies involved immunocompromised patients, including solid organ transplant recipients, patients with autoimmune rheumatic disease, patients with human immunodeficiency virus (HIV) and patients with blood cancers or diseases. Almost all patients received BNT162b2 or mRNA-1273 as fourth dose. All the studies demonstrated the increase of antibody titers after the fourth dose, both in patients who had a serological strong response and in those who had a weak response after the third dose. No serious adverse events after the 4th dose have been reported by 13 studies. COVID-19 infection after the fourth dose ranged from 0 to 21%.Conclusion: The present review highlights the importance of the fourth dose of covid-19 vaccines for immunocompromised patients. Across the included studies, a fourth dose was associated with improved seroconversion and antibody titer levels. In particular, a fourth dose was associated with increasing immunogenicity in organ transplant recipients and patients with hematological cancers, with a very low rate of serious side effects.

Millions of people have died because of the COVID-19 pandemic. The vaccination campaign helped tackle the pandemic and saved millions of lives. In a retrospective pharmacovigilance study, we explored the safety of the BNT162b2 (Comirnaty) vaccine among healthcare workers (HCWs) in a large Italian teaching hospital, and 2428 Adverse Events Reports (AERs) filed by HCWs after the administration of the first dose of vaccine were collected and analyzed, reporting the results quantitively and comparing them to the vaccine Summary of Product Characteristics (SPC). Spearman's correlation coefficients were computed to investigate the correlation among reported adverse effects, and recurrent clusters of symptoms were investigated through the Principal Component Analysis (PCA) and k-means Cluster Analysis. The BNT162b2 vaccine's safety profile was favorable, with predominant reports of early onset, mild, non-serious and short-term resolved symptoms. We observed higher than the expected frequency for various non-serious undesirable effects, especially among those listed and classified as less common in the SPC. Furthermore, we identified three clusters of adverse effects that were frequently reported together, defined by the presence/absence of fatigue, malaise, localized pain, chills, pyrexia, insomnia, nausea and injection site pain. Post-marketing pharmacovigilance activities, together with targeted public health interventions, can be valuable tools to promote vaccination and improve the control of the spread of the pandemic, especially in sensitive settings and populations such as hospitals and healthcare professionals.

Cardiovascular diseases (CVDs) represent a major threat to health and primary prevention outstands as the most effective instrument to face this issue, addressing multiple risk factors at a time and influencing behavioral patterns. Community nurses have been involved in many interdisciplinary prevention activities, resulting in effective control of CV risk factors. We conducted a pilot study aiming at describing the impact on the CV risk profile of an 18-month interdisciplinary intervention on lifestyle habits. From September 2018 to May 2020, four general practitioners (GPs) working in the Roman neighborhood of Torresina recruited patients having a cardiovascular risk score (CRS) equal to or higher than 3% and lower than 20%; those patients were included in a nutritional, physical, and psychological counseling program. Assessments of patients' health status were led at baseline, 6, 12, and 18 months by a nutritionist, a physiotherapist, a psychologist, their GPs, and a community nurse. The CRS was estimated at every examination, based on the Italian Progetto Cuore algorithm. A total of 76 patients were included (mean age of 54.6 years; 33 men and 43 women). Mean CRS showed a significant reduction between baseline and 12 months (from 4.9 to 3.8); both total cholesterol and systolic blood pressure (SBP) significantly decreased at 6 months of follow-up (respectively, from 211.1 to 192 and from 133.1 to 123.1). Nonetheless, the reduction was later maintained only for SBP. However, during the last 6 months of the intervention, the COVID-19 pandemic broke out, thus, it is not possible to know how much the results achieved at 18 months were influenced by the restrictive measures introduced by the Italian government. When stratifying according to the presence of hypertension/diabetes and physical activity, no differences in the CRS could be highlighted between the two groups. Our pilot study proved that an interdisciplinary counseling intervention program can improve CV ri

This study investigates the financial consequences of perceived discrimination towards LGBTQAI+ people in Italy, focusing on psychological support and medication costs. It highlights the burden of discriminatory experiences, emphasizing the need for policies to minimize costs. A cost analysis was performed according to the NHS perspective. A purposive sample was recruited through a web-based survey spread on Italian researchers’ social networks, asking any LGBTQAI+ readers to answer about discriminatory experiences, access to psychological support, and medication use. Costs of health services use were estimated according to the Italian NHS tariffs and Italian Psychologists’ Board. The time horizon was set at one year and discounting was not necessary. Robustness was checked by a one-way sensitivity analysis. A total of 75 LGBTQAI+ people completed the survey. Most of them (aged 26-35 years, 85%; residing in big cities, 70%; unaffiliated with LGBTQAI+ associations, 88%) reported discriminative actions (60%), with 15% seeking psychological help soon after being victim of a single discriminatory act. Verbal and physical abuse were reported by 88% and 6% respectively. 40% of respondents claimed to have resorted to psychotherapy sessions because of the discomfort felt after acts perceived as discriminatory or violent, amounting to 810 total therapy hours. The total therapy cost was E72,900, of which 60% paid as out-of-pocket expenses, and 40% partially covered by regional Local Health Units. Additionally, 12% of respondents used SSRI or benzodiazepines, costing the National Health System an esteemed E3054. The sensitive analysis confirmed the robustness of results. The study demonstrates the significant economic burden of discrimination against LGBTQAI+ individuals in Italy, emphasizing the need for inclusive policies and accessible mental health support. Further research is required to explore indirect costs, for a comprehensive understanding of the total economic impac

Le infezioni correlate all’assistenza (ICA) e la resistenza agli antibiotici (Antimicrobial Resistance, AMR) rappresentano una vera e propria emergenza sanitaria, con un impatto rilevante in termini clinici, sociali ed economici [1]. L’utilizzo eccessivo e inappropriato di farmaci antimicrobici è uno dei principali fattori di insorgenza della resistenza agli antibiotici nei patogeni umani, a causa di mutazioni o scambi genetici che ne facilitano la sopravvivenza. Gli effetti della resistenza, ovvero l’incapacità di un antibiotico, somministrato alle dosi terapeutiche, di ridurre la sopravvivenza o inibire la replicazione di un batterio patogeno, comportano gravi rischi di salute pubblica a livello globale, con aumento di mortalità per infezioni e ingenti costi sanitari e sociali. L’antibioticoresistenza è un fenomeno multifattoriale e multisettoriale, contro il quale interventi singoli e sporadici mostrano un impatto limitato [1, 2]. Una delle più importanti conseguenze derivanti da tale fenomeno è rappresentata dalle ICA che, assenti al momento del ricovero, si manifestano in un individuo durante la degenza in ospedale o in un qualsiasi contesto assistenziale, con una sempre più crescente selezione di ceppi di patogeni Multi-Drug Resistant (MDR). A livello europeo, ogni anno, le ICA colpiscono circa 4 milioni di pazienti e sono causa di oltre 37.000 decessi, di cui solo 10.000 in Italia. I costi per la gestione di queste infezioni, inoltre, superano il miliardo di €/anno, con un impatto economico notevole anche in termini di prolungamento dei tempi di degenza e maggior impiego di antibiotici. I dati provenienti dagli ospedali italiani mostrano un’incidenza di ICA del 5 ± 10%, con un tasso di mortalità fino al 20 ± 30% [1-6]. L’Organizzazione per la Cooperazione e lo Sviluppo Economico (OCSE) ha inoltre stimato che, tra il 2015 e il 2050, circa 2.4 milioni di persone potrebbero morire in Europa, Nord America e Australia a causa di infezioni da superbatteri

Health visitors (HVs) and environmental health officers (EHOs) are the healthcare workers (HCWs) who, in the Italian National Health Service, mainly operate in the prevention departments of local health authorities, guaranteeing the territorial activities specifically declared with the respective professional profiles. During the SARS-CoV-2 pandemic, it was necessary to reallocate all HCWs supporting Hygiene and Public Health Services involved on the front lines of the emergency, in order to perform preventive activities and to take immediate action to fight the spread of the virus. By means of an IT survey consisting of three sections, this study investigated how 960 HVs and EHOs dealt with this reallocation, with the shifting in service assignment, and with the perceived level of fatigue and pressure, through the application of skills acquired from university training. The synergy among the preventive health professions, the ability to work in a multi-professional team, and the complementary training of HCWs represent the main strengths for overcoming future public health challenges, aimed at protecting human health.

The efficacy of the first schedule of COVID-19 mRNA vaccines has decreased after the surge of the Delta variant, posing the need to administer a booster dose to enhance the neutralising immune response. This study aims at evaluating the duration of protection given by the booster dose of Pfizer-BioNTech BNT162b2 mRNA vaccine in healthcare workers (HCWs) of a large teaching hospital in Rome and to analyse the factors associated with post-booster vaccination infections. Data about vaccinations of HCWs with the BNT162b2 vaccine and nasal swabs positive for SARS-CoV-2 were extracted from the digital archives of the hospital from 27 September 2021 to 31 May 2022. In total, 5770 HCWs were observed. The cumulative risk of becoming infected by SARS-CoV-2 increased with time (2.5% at 4 weeks, 17% at 12 weeks and 40% at 24 weeks) and was significantly higher for females, younger classes of patients and for those who had developed a hybrid immunity (natural infection plus one dose, namely the primary schedule, added to the booster dose) compared to those who had completed the three doses. This study describes the duration and the determinants of the protection against infections after the booster dose of COVID-19 vaccine, highlighting the need for continuous monitoring of vaccine-induced immunogenicity.

Le infezioni correlate all’assistenza (ICA) e la resistenza agli antibiotici (Antimicrobial Resistance, AMR) rappresentano una vera e propria emergenza sanitaria, con un impatto rilevante in termini clinici, sociali ed economici [1]. L’utilizzo eccessivo e inappropriato di farmaci antimicrobici è uno dei principali fattori di insorgenza della resistenza agli antibiotici nei patogeni umani, a causa di mutazioni o scambi genetici che ne facilitano la sopravvivenza. Gli effetti della resistenza, ovvero l’incapacità di un antibiotico, somministrato alle dosi terapeutiche, di ridurre la sopravvivenza o inibire la replicazione di un batterio patogeno, comportano gravi rischi di salute pubblica a livello globale, con aumento di mortalità per infezioni e ingenti costi sanitari e sociali. L’antibioticoresistenza è un fenomeno multifattoriale e multisettoriale, contro il quale interventi singoli e sporadici mostrano un impatto limitato [1, 2]. Una delle più importanti conseguenze derivanti da tale fenomeno è rappresentata dalle ICA che, assenti al momento del ricovero, si manifestano in un individuo durante la degenza in ospedale o in un qualsiasi contesto assistenziale, con una sempre più crescente selezione di ceppi di patogeni Multi-Drug Resistant (MDR)

At the onset of the SARS-CoV-2 pandemic, individual and social measures were strengthened through restrictive non-pharmaceutical interventions, labelled with the term "lockdown". In Italy, there were two lockdowns (9 March 2020-3 May 2020 and 3 November 2020-27 March 2021). As part of preventive measures, healthcare workers and the administrative staff population of Policlinico A. Gemelli underwent nasopharyngeal swab tests from 1 March 2020 to 9 February 2022, a long time interval that includes the two aforementioned lockdowns. The population included 8958 people from 1 March 2020 to 31 December 2020; 8981 people from 1 January 2021 to 31 December 2021; and 8981 people from 1 January 2022 to 9 February 2022. We then analysed pseudo-anonymized data, using a retrospective observational approach to evaluate the impact of the lockdown on the incidence of SARS-CoV-2 infections within the population. Given the 14 day contagious period, the swab positivity rate (SPR) among the staff decreased significantly at the end of the first lockdown, every day prior to 18 May 2020, by 0.093 (p < 0.0001, CI = (-0.138--0.047)). After the fourteenth day post the end of the first lockdown (18 May 2020), the SPR increased daily at a rate of 0.024 (p < 0.0001, 95% CI = (0.013-0.034)). In addition, the SPR appeared to increase significantly every day prior to 17 November 2020 by 0.024 (p < 0.0001, CI = (0.013-0.034)). After the fourteenth day post the start of the second lockdown (17 November 2020), the SPR decreased daily at a rate of 0.039 (p < 0.0001, 95% CI = (-0.050--0.027)). These data demonstrate that, in our Institution, the lockdowns helped to both protect healthcare workers and maintain adequate standards of care for COVID and non-COVID patients for the duration of the state of emergency in Italy.

Vaccinations generate health, economic and social benefits in both vaccinated and unvaccinated populations. The aim of this study was to conduct a cost–benefit analysis to estimate the costs and benefits associated with the COVID-19 vaccination campaign for health workers in Fondazione Policlinico Universitario Agostino Gemelli IRCCS (FPG). The analysis included 5152 healthcare workers who voluntarily received the Pfizer–BioNTech COVID-19 vaccine, divided into physicians, nurses and other health workers. Data about vaccine cost, administration and materials were derived from administrative databases of the FPG from 28 December 2020 to 31 March 2021. The costs associated with the COVID-19 vaccination campaign amounted to EUR 2,221,768, while the benefits equaled EUR 10,345,847. The benefit-to-cost ratio resulted in EUR 4.66, while the societal return on investment showed a ratio of EUR 3.66. The COVID-19 vaccination campaign for health workers in FPG has high social returns and it strengthens the need to inform and update decision-making about the economic and social benefits associated with a vaccination campaign. Health economic evaluations on vaccines should always be considered by decision-makers when considering the inclusion of a new vaccine into the national program.

Introduction: Vaccine hesitancy threatens the health of populations and challenges Public Health professionals. Strategies to reduce it aim to improve people's risk perception about vaccine-preventable diseases, fill knowledge gaps about vaccines and increase trust in healthcare providers. During pregnancy, educational interventions can provide a proper knowledge about safety and efficacy of maternal and childhood vaccinations. Fighting hesitancy and clarifying doubts is fundamental during the COVID-19 pandemic, which may have affected people's knowledge and beliefs toward vaccination. This study aimed at assessing if the advent of the pandemic was associated with changes in pregnant women's knowledge and beliefs toward vaccination, and trust in healthcare services. Methods: A repeated cross-sectional study was conducted through self-reported questionnaires in a Roman teaching hospital, where educational classes about vaccinations are routinely held as part of a birthing preparation course. Data were collected on a sample of pregnant women before and during the pandemic. Free-of-charge flu vaccinations were offered to all course participants and adherence to flu vaccination was assessed. Results: The proportion of pregnant women reporting that vaccines have mild side effects and that are sufficiently tested increased from 78.6 to 92.0% (p = 0.001) and from 79.4 to 93.2% (p = 0.001), respectively. There was a reduction from 33.0 to 23.3% (p = 0.065) in the proportion of those declaring that healthcare workers (HCWs) give information only on the benefits and not on the risks of vaccines, and a reduction from 27.3 to 12.1% (p = 0.001) in those reporting that vaccines are an imposition and not a free choice of mothers. Trust in National Health Service (NHS) operators slightly decreased. Among participants, the monthly flu vaccination adherence ranged from 50.0% in November to 29.2% January for 2019-20 flu season, and from 56.3% in September to 14.5% in January for 2020

Vaccine hesitancy in healthcare workers (HCWs) has been studied for various contagious diseases, but there is still insufficient knowledge about this phenomenon for COVID-19. We developed and validated a knowledge, attitude, and practice survey of 39 questions to assess Italian HCWs' hesitancy toward vaccination in general (general hesitancy), COVID-19 vaccination (COVID-19 hesitancy), and public health injunctive measures (refusal of obligations). The survey was administered through a web platform between July and November 2021. Three multivariable logistic regressions were performed to evaluate the association between the explored dimensions of hesitancy and the potential determinants investigated. Out of 2,132 respondents with complete answers, 17.0% showed to be generally hesitancy toward vaccination, 32.3% were hesitant on COVID-19 vaccination, while 18.8% were categorized as refusing obligations. A significant protective effect against all three dimensions of hesitancy was found for increasing fear of COVID-19, advising COVID-19 vaccination to relatives and patients, having received flu vaccination in the previous year and having higher levels of education. Better self-rated knowledge about COVID-19 vaccines and reading up institutional sources were significantly protective against general and COVID-19 hesitancy, while being a physician rather than another healthcare professional was protective only against COVID-19 hesitancy. Conversely, increasing age and referring to colleagues to expand knowledge about COVID-19 were positively associated with COVID-19 hesitancy. The determinants of general hesitancy, COVID-19 hesitancy and the refusal of obligations are mostly overlapping. Given the great influence they exert on patients and communities, it is pivotal to limit HCWs vaccine hesitancy through appropriate training activities.

Healthcare workers (HCWs), particularly physicians, are a relevant and trusted source of information for patients, especially when health-related choices such as vaccination are concerned. Between July and November 2022, we administered a web-based survey to physicians and dentists living in the Latio region of Italy to explore whether their background might affect their willingness to recommend the COVID-19 vaccination to their patients (RCVtoPat) and their relatives (RCVtoRel). We performed a multivariable logistic regression to study the association between the two outcomes (RCVtoPat and RCVtoRel) and their potential determinants in our sample (n = 1464). We found that being a dentist, an increasing fear of COVID-19, and having been previously vaccinated against flu are positively associated with both RCVtoPat and RCVtoRel, while a better self-rated knowledge of COVID-19 vaccines is associated only with RCVtoRel. No role was found for age, sex, civil status, education level, information sources, previous SARS-CoV-2 infection, and chronic diseases. A subgroup analysis of physicians alone (n = 1305) demonstrated a positive association with RCVtoRel of being specialized in diagnostic/therapeutic services and a negative effect on RCVtoPat of being trained in general practice. We provide useful insights about the factors that should be addressed to ensure HCWs exert a positive influence on their patients and communities.

To maintain safety conditions in the provision of care and assistance, and to protect healthcare workers (HCWs) and patients, the Italian government required compulsory COVID-19 vaccination for HCWs, including medical residents (MRs). The aim of this study was to assess COVID-19 vaccination coverage in MRs in a large tertiary hospital in Italy, before and after the introduction of compulsory vaccination, according to demographic characteristics and specific residency. A database on COVID-19 vaccination status and infection of resident medical doctors was created. Descriptive statistics and logistic regressions were carried out on the data. A total of 1894 MRs were included in the study. Being vaccinated in the same hospital as the residency program was significantly related to the year of residency and being enrolled in a frontline residency. A significant association between compliance with the compulsory primary cycle vaccination and vaccination in the hospital residency was observed. Being enrolled in the second, third, and last years of residency, and in a frontline residency, were predictive of being vaccinated in the residency hospital. Almost 100% of the MRs participating in the study were vaccinated against COVID-19. Compulsory vaccination of HCWs, alongside greater and clearer information about the risks and benefits of vaccination, represents an important booster to ensure public health and to promote quality and safety of care.

At the onset of the SARS-CoV-2 pandemic, individual and social measures were strengthened through restrictive non-pharmaceutical interventions, labelled with the term "lockdown". In Italy, there were two lockdowns (9 March 2020-3 May 2020 and 3 November 2020-27 March 2021). As part of preventive measures, healthcare workers and the administrative staff population of Policlinico A. Gemelli underwent nasopharyngeal swab tests from 1 March 2020 to 9 February 2022, a long time interval that includes the two aforementioned lockdowns. The population included 8958 people from 1 March 2020 to 31 December 2020; 8981 people from 1 January 2021 to 31 December 2021; and 8981 people from 1 January 2022 to 9 February 2022. We then analysed pseudo-anonymized data, using a retrospective observational approach to evaluate the impact of the lockdown on the incidence of SARS-CoV-2 infections within the population. Given the 14 day contagious period, the swab positivity rate (SPR) among the staff decreased significantly at the end of the first lockdown, every day prior to 18 May 2020, by 0.093 (p < 0.0001, CI = (-0.138--0.047)). After the fourteenth day post the end of the first lockdown (18 May 2020), the SPR increased daily at a rate of 0.024 (p < 0.0001, 95% CI = (0.013-0.034)). In addition, the SPR appeared to increase significantly every day prior to 17 November 2020 by 0.024 (p < 0.0001, CI = (0.013-0.034)). After the fourteenth day post the start of the second lockdown (17 November 2020), the SPR decreased daily at a rate of 0.039 (p < 0.0001, 95% CI = (-0.050--0.027)). These data demonstrate that, in our Institution, the lockdowns helped to both protect healthcare workers and maintain adequate standards of care for COVID and non-COVID patients for the duration of the state of emergency in Italy.

Introduzione La vaccinazione antinfluenzale è efficace nel prevenire l’influenza stagionale, protegge i pazienti fragili dalle complicanze dell’influenza, diminuisce l’assenteismo nel personale riducendo, così, i costi risultanti dalla conseguente perdita di produttività. La copertura vaccinale antinfluenzale tra gli operatori sanitari in Italia è ancora molto bassa e si attesta approssimativamente attorno al 15% in base alle più recenti indagini. Il tasso di copertura vaccinale nel nostro Policlinico Universitario è cresciuto da 9,57% durante la stagione 2016-2017 a 14,24% in quella 2017- 2018 fino ad arrivare a 22,38% nell’ultima stagione 2018-2019. Lo scopo di questo studio retrospettivo osservazionale è dimostrare la sostenibilità sostenibilità economica dell’introduzione di un incentivo non economico consistente in un’ora aggiuntiva di permesso retribuito a tutti gli operatori sanitari della Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS che accettano di vaccinarsi. Materiali e metodi È stata effettuata un’analisi cost-consequence (utilizzando il metodo del costo frizionale) stimando la perdita di produttività pro-capite causata dall’assenteismo per malattia. È stato dunque calcolato il salario orario medio degli operatori sanitari (stratificati per categoria professionale) per identificare il costo di un’ora di permesso retribuita. È stata, infine, stimata la quantità massima di permesso retribuito concedibile senza perdite nette per l’azienda. Risultati È stata registrata una perdita di produttività annuale dovuta ad assenteismo per malattia pari a 237,65 € per ogni operatore vaccinato e pari a 413,78 € per ogni operatore non vaccinato. La differenza in perdita di produttività pro-capite annua è risultata, pertanto, di 176,13€. Considerando 36,89 €/h come il salario orario medio pesato per categoria professionale, l’applicazione dell’incentivo risulta sostenibile. La nostra simulazione ha identificato 4,77 ore (286,5 minuti) c

Introduzione Gli strumenti di risk management in ambito sanitario sono sempre più utilizzati. Tra questi soprattutto quelli proattivi, in grado di identificare i potenziali punti di debolezza del sistema per elaborare misure correttive prima del verificarsi di un evento avverso, sono un valido strumento per la governance dei processi. Scopo del presente studio è la validazione di una FMECA per identificare e quantificare situazioni a rischio di contaminazione microbiologica nel processo di raccolta e produzione di unità di emocomponenti per uso clinico, in una logica di miglioramento continuo della qualità. Materiali e metodi Il Servizio di Emotrasfusione della struttura in studio produce ogni anno circa 27.000 unità di emocomponenti, tra quelle ad uso trasfusionale e plasma destinato all’industria farmaceutica. Oltre alla regolare attività di autocontrollo svolta dal Servizio, l’Unità Operativa Complessa di Igiene Ospedaliera effettua saggi di sterilità per il controllo di processo. È stato costituito un gruppo di lavoro composto da medici Igienisti specialisti e in formazione, emotrasfusionisti e biologi, per elaborare un modello di FMECA mediante un’assegnazione condivisa di punteggi a tre parametri (punteggio 1-10 per ciascun parametro, secondo le scale proposte dal Centro Nazionale Sangue): Probabilità che l’evento accada; Rilevabilità della Failure; Gravità delle conseguenze. Il prodotto di questi tre valori rappresenta l’Indice di Priorità del Rischio (IPR). Sono state considerate rilevanti, ai fini di programmazione dei saggi di sterilità, le attività con IPR > 100 o con valore di Gravità superiore ad 8. Per ogni possibile failure è stata pianificata l’azione correttiva da adottare. Risultati L’FMECA è stata scomposta in quattro macrofasi principali: raccolta del sangue intero o emocomponenti; emazie; plasma; concentrati piastrinici. Complessivamente sono state analizzate 13 fasi e 26 sottofasi: su un totale di 43 modalità di errore, il

Introduzione La vaccinazione è un atto medico di fondamentale importanza e rappresenta uno tra gli interventi più efficaci e sicuri in Sanità Pubblica. L’introduzione dell’obbligo vaccinale con il Decreto Legge 73/2017 ha portato a un aumento delle coperture vaccinali (CV) con risultati incoraggianti ma non del tutto soddisfacenti. Lo studio si propone di evidenziare i dati ottenuti in cinque Regioni Italiane prese come riferimento (Lombardia, Veneto, Emilia-Romagna, Toscana, Puglia) circa il vaccino Esavalente e anti-MPR, relative a tutto l’anno 2018 nelle coorti di nati nel 2016 a 24 mesi. Materiali e metodi È stata condotta una revisione circa i dati intermedi e finali relativi le CV che ha permesso di analizzarne il trend con particolare riferimento al vaccino Esavalente e anti-MPR. L’analisi statistica condotta ha evidenziato le differenze rispetto ai dati dell’anno 2017, considerando sia i dati grezzi sia i dati aggiustati. Risultati Si evidenziano differenze dei valori delle CV tra le Regioni e anche all’interno della stessa Regione, con un incremento non omogeneo. In particolare, rispetto all’anno 2017: • le CV per Esavalente e anti-MPR in Lombardia raggiungono rispettivamente il 95.2% (+0.9%) e il 94.1% (+0.2%); • il Veneto mostra un incremento compreso tra l’1.3% e l’1.8% per le vaccinazioni contenute nell’Esavalente, non superando tuttavia il 93.7%; l’anti-MPR raggiunge il 92.7% (+1.2%); • la CV per l’Esavalente in Emilia-Romagna passa dal 94.7% al 95.7% (+1%); l’anti-MPR dal 91.1% al 93.5% (+2.4%); • le CV per Esavalente e anti-MPR in Toscana passano rispettivamente dal 95.8% al 96.8% (+1%) e dal 93.5% al 95.32% (+1.8%); • le CV per l’Esavalente in Puglia passano dal 94.4% al 95.2% (+0.8%); quelle per l’anti-MPR dal 91.1% al 94.2% (+3.1%); in tale regione si evidenzia l’aumento percentuale maggiore per la vaccinazione anti-MPR. Conclusioni Nonostante l’introduzione dell’obbligo vaccinale e il conseguente aumento delle CV, la Regione Toscana è la sol

L’incidenza e la prevalenza delle malattie cardiovascolari sono in aumento nei paesi sviluppati e in via di sviluppo, così come le ospedazzazioni. per ridurre il rischio di insorgenza di malattie cardiovascolari è importante promuovere interventi di prevenzione primaria. Questo studio sperimentale prospettico ha l’obiettivo di attuare interventi di prevenzione e promozione della salute sulla popolazione per ridurre l’impatto delle malattie cardiovascolari e le conseguenze sulla morbilità e mortalità, valutandone in via esplorativa l’efficacia. Materiali e metodi Lo studio è in corso e durerà 18 mesi. Il campione è stato reclutato negli ambulatori di medicina generale del quartiere Torresina-Roma. Sono previsti incontri con il MMG, l’infermiere di comunità, professionisti dedicati (nutrizionista, fisioterapista, psicologo), ed eventi outdoor con un coach per promuovere l’attività fisica di gruppo. Attraverso canali social dedicati viene favorita l’interazione tra partecipanti, professionisti e organizzatori. Al tempo 0 e durante follow-up a 2 mesi sono raccolti dati antropometrici ed ematochimici, stili di vita, alimentazione, attività fisica e benessere psicologico; viene inoltre calcolato il Punteggio individuale di Rischio Cardiovascolare (PRC). L’efficacia degli interventi è valutata sulla base della variazione nel tempo dei parametri raccolti. È prevista, infine, la valutazione degli arruolati dopo 6 mesi dal termine dello studio per determinare la capacità di autogestire nel tempo un corretto stile di vita. Risultati Il campione, 36 (43,9%) maschi e 46 (56,1%) femmine, ha un’età media di 53 anni. 44 (53,7%) arruolati hanno partecipato ad almeno 3 dei 4 incontri previsti. Il BMI medio è 27,4 ± 4,9, senza differenze significative per genere, età o stato di fumatore. Il PRC al tempo 0 evidenzia differenze (p < 0,001) per genere (5,5% dei maschi vs 4,0% delle femmine), per età (1,7% infra-50enni vs 6,9% ultra-50enni) e per stato di fumatore (3,5

Building-work activities could cause dust contamination and fungal spores’ dissemination. A significant relationship was found between building-work activities and the incidence of invasive aspergillosis, in profoundly immunocompromised patients. Renovation-works activities were carried out by four building sites of the hematology ward in a Teaching Hospital without the interruption of clinical activities. These sites were monitored by environmental sampling to determine the particles and fungi count. Clinical surveillance was made using galactomannan antigen test as a proxy for invasive aspergillosis diagnosis. A definitive diagnosis of IA was confirmed by clinical and radiological features. The galactomannan antigen test showed no significant difference between presence (2,75%) and absence (5,03%) of renovation work activities (p=0,522). During the renovation activities, an increment of IA cases with respect to the control period was not recorded. The particle counts showed higher values of small and big-diameter particles before the renovation works if compared to the end of the activities. It was probably due to the containment measures implemented during and immediately after the final phases of the building site. The Fungi counts showed no significant differences between the phase before and after the renovation activities. Our findings show that is possible to perform renovation work, during clinical activities, by increasing clinical and environmental surveillance

The Authors present their two-year experience regarding an evaluation of the hygienic quality of ready-to-eat foods in a hospital foodservice, both for patients' meals and hospital staff, prepared by using the Cook Chill system. According to the microbiological parameters provided by International Guidelines, 23 of 27 food samples that were collected and analyzed were found to be satisfactory, one was acceptable and only three were unsatisfactory (two for aerobic colony count and one both for aerobic colony count and hygienic procedure). Escherchia coli, Staphylococcus aureus, Salmonella, Listeria monocytogenes, and Clostridium perfringens were absent in all of the analyzed products, The study results are encouraging and confirm the need to always verify that the different phases of production of hospital meals are correctly implemented, even when the foodservice is out-sourced. This has always been considered a priority in the study hospital, where the Health Department is at the forefront both in control and verification of food safety practices and in offering training activities, especially in view of the increased susceptibility of hospitalized patients.

Vaccination of healthcare workers (HCWs) is a public health tool of the utmost importance and the Italian National Vaccine Prevention Plan (PNPV) 2017-2019 recommends several vaccinations in this population group. Nevertheless, vaccine hesitancy is influencing HCWs' attitude towards vaccination. Moreover, a large number of measles cases have been reported in Italy among HCWs in 2017 and 2018. In Italy there is no national registry for vaccinations, so data on vaccine coverage among HCWs are not readily accessible. The aim of this literature review is to describe the most recent data about vaccination coverage among HCWs in Italy. We also report studies that evaluated the effectiveness of strategies to increase influenza vaccine uptake. We included all studies conducted in Italy and published between 2008 and 2018, regarding vaccines recommended by the PNPV 2017-2019 (hepatitis B, influenza, pertussis, measles, mumps, rubella, varicella, and tuberculosis). Our findings confirm that low vaccination coverage levels among HCWs exist in several Italian regions and cities, highlighting a relevant gap towards targets set by the PNPV. Studies that evaluated the effectiveness of multicomponent interventions to increase vaccination coverage found only minimal to moderate increases in uptake levels. It is therefore crucial to tackle vaccine hesitancy in HCWs, by identifying effective strategies able to significantly increase vaccine coverage, in order to decrease the risk of nosocomial infections, prevent transmission of preventable diseases to patients, and reduce indirect costs related to HCW absenteeism due to illness.

Flu vaccination, as well as being effective to prevent seasonal influenza, decreases staff illness and absenteeism and reduces costs resulting from loss of productivity. Despite the effectiveness of flu vaccination, the seasonal coverage among healthcare workers is usually low. The aim of this retrospective observational study was to analyze the vaccination coverage rate among all employees (healthcare workers and administrative staff) of a large teaching hospital in Rome during the 2017-2018 influenza season, to perform a cost-consequence analysis of influenza vaccination (by evaluating the absenteeism due to illness in the epidemic period), and to assess the impact of vaccination in terms of both costs and sick days. The flu vaccination coverage rate was 9.8% among 4631 healthcare workers and 852 administrative employees. The human capital approach estimated a loss of productivity equal to 297.06 € for each vaccinated worker and 517.22 € for each unvaccinated worker (cost-outcome ratio: 120.07 €/sick day). Applying the friction cost method, a loss of productivity equal to 237.65 € for each vaccinated worker and 413.78 € for each unvaccinated worker (cost-outcome ratio: 104.19 €/sick day) was found. These results confirm the benefits of the flu vaccination for the society and the company. This allowed the management to grant one hour of permission to the flu-vaccinated workers in the following annual vaccination campaign (2018-2019).

BACKGROUND: Clostridium Difficile Infections (CDIs) have been increasing both in incidence and in severity, representing a big public health concern. AIM: The aim of this study was to evaluate the impact of a recently implemented Critical Pathway (CP) focused on patients with CDI in an Italian Teaching Hospital. METHODS: The CP implementation consisted of intervention aimed to: faster diagnosis and appropriateness in admission and discharge point of care; activation of a multidisciplinary team; staff training; information to patients and caregivers. In a pre-post retrospective observational study, volume, process and outcome indicators were analyzed. FINDINGS: A total of 228 patients (128 in 2013 and 100 in 2016) were included. A decrease in the absolute number of access to the Emergency Department (p=0.02) and an increase in hospitalization in more appropriate ward (ie gastroenterology ward, p<0.001) were found. The median hospital length of stay decreased from 20.5 (12.5-31) days in 2013 to 16.5 (7-31) days in 2016 (p=0.05). With regards to outcome indicators, an increase of discharge to home and a decrease of discharge to long term facilities were showed (p=0.01 both). Despite a reduction, no statically significant differences in mortality between 2013 and 2016 were revealed by the analysis. CONCLUSION: In conclusion, we found out a quality improvement in patient hospital management. Our experience confirms that the implementation of the CP increases the appropriateness in hospital quality of care.

The prevention of Legionella colonization of water systems is one of the goals of hospital management. Among chemical disinfection methods, chlorine dioxide (ClO2) has been largely used to control Legionella spp. in water systems. We performed a retrospective study to analyse data deriving from the surveillance plan of the water system in a large academic hospital in Rome (Italy) during the period August 2011 and August 2018. We collected the data deriving from the routine water samples used to monitor Legionella spp. colonization. Data from the water samples collected from 163 selected sampling points (hot water tanks, the return loop and distal outlets) was analysed using a life table analysis in order to investigate the duration of the effectiveness of the ClO2 method in eradicating Legionella spp. The colonization of the water sample by Legionella spp. was considered as the outcome. Our results show that in 81,59% of the sampling points Legionella spp. were never detected at four years of follow up. Chemical and physical characteristics of the water were also compared between the samples which were positive for Legionella spp. and those which were not. No association was found between these factors. The knowledge of the duration over time of the effectiveness of the ClO2 disinfection method could support decision-making processes in the framework of Risk Management activities in hospitals. Future studies could also be conducted in hospitals to compare the long-term cost-effectiveness of different Legionella spp. colonization prevention methods.

We analysed the impact of several strategies aimed at increasing influenza immunisation rates among Medical Residents (MRs) of an Italian teaching Hospital. During the 2015–16 and 2016–17 influenza seasons we carried out several interventions: ambulatory doubling where vaccination was offered, ambulatory opening hour extension, email invitations, informative materials, forum theatre and vaccination campaign conference. In addition, during the 2016–17 the OSV was carried out: MRs who go to specific wards where they perform influenza immunisation counselling and eventually vaccinate the personnel. 99/1041 (9.5%) and 184/1013 (18.2%) MRs received the vaccine in 2015–16 and in 2016–17 respectively (p < 0.0001). Significant difference was found among three specialisation areas (medicine, surgery, “services”; p < 0.001) and among years of residency (p < 0.001). The highest coverage was found among Infectious Diseases, Paediatrics, Haematology and Hygiene MRs (80%, 67%, 52% and 52% respectively) in 2016–2017 season. The highest coverage increase was found among MRs in Pneumology and Geriatrics (566% and 268%, respectively). The coverage rate has increased even though important differences among specialties persist. The study shows a significant increase in immunisation rate among MRs after the implementation of these strategies.

INTRODUZIONELe infezioni correlate all’assistenza (ICA) rappresentano una delle più frequenti complicanze delle prestazioni ospedaliere e al contempo una delle sfide principali della sanità pubblica del Paese. Al fine di delinearne al meglio l’impatto, risultano fondamentali le attività di sorveglianza attiva attraverso indagini di prevalenza e incidenza.MATERIALI E METODI Dal 11 al 13 ottobre 2017, è stata condotta nelle degenze ordinarie del Policlinico Universitario un’indagine di prevalenza puntuale sulle infezioni nosocomiali.Sono state acquisite informazioni sulla presenza fattori di rischio per l’insorgenza di infezioni ospedaliere (interventi chirurgici nei 30 giorni antecedenti la rilevazione, provenienza da casa di cura, RSA o centri dialisi negli ultimi 90 giorni, isolamento di microrganismi MDR negli ultimi 90 giorni, presenza di un catetere urinario a permanenza, antibioticoterapia, tipologia di microrganismi isolati). Per la rilevazione è stato utilizzato un apposito software.RISULTATI Sono stati arruolati 1106 pazienti.Nel 2017, i pazienti con almeno una ICA sono stati 34, per un numero complessivo di 35 casi (62 casi nel 2016, 5,48% di prevalenza; p=0,025) mentre la prevalenza complessiva delle ICA è stata del 3,16%.La prevalenza per la tipologia di Specialità secondo classificazione ECDC si è dimostrata più alta nell’Area Medica (4,72%) con 22 casi di ICA rilevati. Più interessante appare il decremento, rispetto al 2016, osservato nei reparti di specialità chirurgica (7,5% nel 2016 vs 1,78% nel 2017; p=0,002) e, anche se non significativo, in quelli della specialità ginecologica (5,7% nel 2016 vs 2,3% nel 2017; p=0,247) e nelle terapie intensive (8,2% nel 2016 vs 4,35% nel 2016; p=0,231).Per quanto riguarda la tipologia di ICA, le infezioni del torrente ematico, con 11 casi, costituiscono la tipologia più frequente (0,99%), seguite dalle polmoniti con 9 casi (0,81%) e le Infezioni delle vie urinaria con 8 casi (0,72%).Rispetto al 2016

INTRODUZIONELa vaccinazione antinfluenzale annuale degli Operatori Sanitari (OS) è raccomandata per prevenire l’influenza ed evitarne la trasmissione ai pazienti fragili. Nel periodo influenzale epidemico, l’assenza dal lavoro per malattia degli OS, inoltre, può generare inefficienze organizzative su qualità e continuità delle cure prestate ai pazienti. Nel nostro Policlinico Universitario, la copertura vaccinale antinfluenzale tra gli OS nella stagione 2016-17 è risultata intorno al 9%. Per tale motivo, durante la stagione 2017-18 sono state adottate diverse strategie per aumentare la copertura. Obiettivo del presente studio è quello di valutare l’efficacia di queste strategie integrate e analizzare, inoltre, l’impatto della vaccinazione sull’assenteismo per malattia degli OS nel periodo epidemico.MATERIALI E METODIDurante la stagione influenzale 2017-18, in circa metà delle Unità Operative della Fondazione Policlinico Universitario “A. Gemelli” IRCCS (FPG) sono stati attuati interventi formativi “peer” (academic detailing) e sessioni di vaccinazione on-site per aumentare conoscenze, attitudini e tasso di copertura vaccinale antinfluenzale tra gli OS.Al termine della stagione 2017-18, è stato realizzato uno studio trasversale al fine di analizzare la copertura vaccinale antinfluenzale tra gli OS della FPG. Dati socio-demografici e occupazionali (età, genere, vaccinazione antinfluenzale nella precedente stagione 2016-17, professione e Unità Operativa di afferenza) sono stati forniti dal Servizio di Medicina Preventiva e dalla Direzione Risorse Umane; quest’ultima ha fornito anche il numero di giornate di malattia usufruite dagli OS nel corso del periodo epidemico (42° settimana 2017 – 17° settimana 2018).RISULTATILo studio ha incluso 4111 OS della FPG. Il tasso di vaccinazione antinfluenzale è aumentato dall’8.7% del 2016-17 al 13% del 2017-18 (+48.5%, p<0.0001). L’analisi multivariata ha evidenziato che, al termine della stagione 2017-18, la copertur

INTRODUCTION: The Hospital Hygiene Unit ensures hospital patient safety, through surveillance and control of environmental conditions of risk. In this context, resident physicians in Hygiene and Preventive Medicine of the Catholic University of the Sacred Heart (UCSC) are required to attend the unit to acquire professional skills, for two months (four weeks in the first year of residency and four weeks in the second year). In the initial phase of the rotation, residents are acquainted with the organization and assigned activities. Ongoing meetings with the tutor take place to verify the progress of activities in which they are involved; verification of acquired skills is performed at the end of the period of attendance. The aim of the study was to evaluate resident doctors' opinions about their training experience, in order to assess the perceived quality and pursue continuous improvement of the training program. MATERIALS AND METHODS: A questionnaire was administered to resident physicians attending the first three years of residency; the survey consisted of 11 multiple choice questions on organization, attendance, training and overall satisfaction and 3 open-ended questions on strengths, weaknesses and proposals for improvement. RESULTS: Fourteen of 15 residents (93.3%) completed the questionnaire: seven were male, five were first-year residents, five were second-year and four were third-year residents. Overall, 78% gave a positive assessment of the quality of training; in particular, 11 of 14 residents reported that the experience was very relevant to their training in Hygiene and Preventive Medicine. Responses regarding the training organization were also mostly positive (75%), as were those regarding attendance (57%) and overall satisfaction (67%). Fifty percent reported difficulties in combining this internship with the other activities planned with their tutor. CONCLUSIONS: Positive opinions prevail in all areas of assessment, although there are some aspects

Background: Progressive patient care (PPC) has been defined as a systematic classification and segregation of patients based on their medical and nursing needs. Aim of the present research was to perform a systematic literature review about existing medical intermediate care unit organizational models and their performance strengths and weaknesses with a specific focus on Italian implementation, respect to US model. Methods: Databases PubMed, Cinahl, Google and Google Scholar were searched until September 2017. The search was limited to Italian and English studies. All study design are included in the review. Results: Ten studies were included in the review. The American studies showed, after the PPC reorganization, an increase in level of satisfaction and nursing care, a reduction in average length of stay, costs and tensions between nurses and an improvement in nurse-physician communication. An Italian study reported the results of a project carried out in three case studies (Forlì, Foligno and Pontedera hospital), redesigning hospital patient flow logistics around the concept of intensity of care: in all three cases, after the reorganization, an increase in bed occupancy rate (before: 71%,81%,65%; after: 78%,84%,82%, respectively) and in hospital case-mix complexity (average DRG weight-before: 0.99,1.07,1.12; after: 1.19,1.09,1.61, respectively) and a reduction in turn-over ratio (before: 2.5,1.4,2.8; after: 1.5,1.2,1.7, respectively) was recorded. Considering Italian healthcare professionals’ point of view, majority of internists supported a hospital remodeling according to PPC model. Conclusions: The PPC model, theorized in US, has found several applications in Italian regional realities. Improvements in quality of care, appropriateness and productivity in healthcare facilities, that adopted the PPC program, were observed.

INTRODUCTION: Obesity is a major public health problem because it is a risk factor for various chronic diseases and its incidence is constantly increasing due to changes in diet and lifestyle. In Italy, studies show that 32% of the population aged between 18 and 69 years is overweight and 10% is obese. The aim of this study was to measure the anthropometric characteristics of a sample population of the city of Rome (Italy) and correlate these with dietary habits and socio-demographic characteristics of participants in order to evaluate their specific health and educational needs. METHODS: A cross-sectional study was conducted in February 2015 by administering an ad-hoc questionnaire to subjects over 18 years of age attending a General Practitioner's practice in Rome (Italy). The questionnaire collected demographic, clinical and anthropometric data, and information regarding dietary habits. RESULTS: The sample consisted of 150 individuals with a mean age of 47,8 years. Fifty nine percent were women. The mean Body Mass Index (BMI) was 26.7. The average blood pressure was 131/80 mmHg. BMI values were higher in respondents with a lower educational level and BMI was significantly associated with the quality of the source of nutrition information used. CONCLUSIONS: Poor and unreliable information regarding proper nutrition can correlate with the risk of overweight and the consequent development of chronic diseases. The family or community nurse could play a critical role in prevention, by helping to provide correct information for specific populations and by planning training and prevention activities with the GP.

INTRODUCTION: In Italy annual flu vaccination for health care workers is recommended but coverage is usually unsatisfying. The compliance is even worse among medical residents (MRs) both in literature, both in our experience: in the flu season 2014/ 15 only 0.6% of MRs enrolled at the Università Cattolica del Sacro Cuore (UCSC) were vaccinated. For this reason, during the influenza season 2015/16, the Institute of Public Health of the UCSC, in collaboration with the Health Management of the "Agostino Gemelli" Teaching Hospital (FPG) and with the directive board of the Medical Specialization Schools (SSM) present at the University has tested several strategies to improve awareness and adherence to flu vaccination campaign by its staff. This study aims to analyze the impact of the strategies used during the 2015/16 campaign on flu vaccination coverage among MRs of an important Italian Teaching Hospital. METHODS: The study was conducted among MRs enrolled at the UCSC - FPG in 2015/16. The data was collected by the Occupational Medicine which, during the influenza seasons, immunize MRs against influenza free of charge. For each variable - vaccination, area of specialization (surgical, medical, clinical services), typology of SSM - was measured the absolute and percentage frequency. In order to compare the flu vaccination coverage between seasons 2014/15 and 2015/16 and between areas of specialization in 2015/16 chi-square test was used (statistical significance level of 0.05). The data were analyzed using STATA Software. RESULTS: Were included in the analysis 42 SSM with a total of 1041 MRs. During the vaccination campaign 2015/16, flu vaccine was administered to 99 MRs (9.5%), 8.9% more than in the previous season (p<0.001). There is also a significant difference in vaccine coverage between surgical, medical and clinical services areas in 2015/16 (p <0.001). The highest vaccination coverage was recorded among MRs of Hematology and Urology (54.5%). However, no one MRs

The Authors describe the results of inspections carried out in 22 street food outlets in the city of Rome, Italy, from 7 April to 28 May 2014. In general, structural requirements of outlets were met but some critical aspects related to hygiene, in particular of instruments, surfaces and worktops, were identified. Results suggest the need to ensure compliance with sanitation requirements of this particular type of food outlet, in order to ensure food safety and, consequently, consumers' health.

Antibiotic resistance is one of the most relevant problems in the healthcare: the growth of resistant microorganisms in healthcare settings is a worrisome threat, raising length to stay (LOS), morbidity and mortality in those patients. The importance of the antibiotic resistance and its spread around the world, gave rise to the activation of several surveillance systems, based especially on the collection of laboratory data to local or national level. The objective of this work is to carry out a review of the scientific literature existing on the topic and scientific activities related to surveillance of antibiotic resistance in the countries bordering the Mediterranean Sea. Recent Data from European Centre for Disease Prevention and Control (November 2015) show, for different combinations bacterium-drug, an increase of resistance from North to South and from West to East of Europe. It is of particular concern the phenomenon of resistance carried out by some gram-negative, specifically Klebsiella pneumoniae and Escherichia coli to third-generation cephalosporin, often combined in opposition to fluoroquinolones and aminoglycosides. Is particularly high the incidence of resistance to carbapenems by strains of Enterobacteriaceae (Klebsiella included). The resistance exerted by MRSA (Methicillin-resistant Staphylococcus aureus) continues to be relevant, albeit showing some decline in recent years. The incidence of resistance carried on by Streptococcus pneumoniae is stable and is mainly relevant to macrolides. Finally, a significant increase in recording relatively exercised by Enterococcus faecium to Vancomycin. Detecting, preventing, and controlling antibiotic resistance requires strategic, coordinated, and sustained efforts. It also depends on the engagement of governments, academia, industry, healthcare providers, the general public, and the agricultural community, as well as international partners. Committing to combating antibiotic-resistant microbes does support

INTRODUZIONE L’obesità è uno dei principali problemi di salute pubblica sia perché è considerata un fattore di rischio per l’insorgenza di patologie croniche sia perché è in costante crescita. Le principali cause dell’aumentata incidenza di tale condizione sono da ricercare nelle modifiche del regime alimentare e dello stile di vita degli ultimi 50 anni. Lo scopo di questo studio è condurre una survey sulle abitudini alimentari e lo stile di vita in un campione di pazienti afferenti al Medico di Medicina Generale per conoscerne i bisogni e pianificare strategie di intervento efficaci atti a modificare importanti determinanti di salute. MATERIALI È stato utilizzato un questionario che raccoglie informazioni circa le caratteristiche antropometriche e sanitarie, le abitudini alimentari e le caratteristiche socio-demografiche del campione studiato. Il questionario è stato distribuito nel mese di febbraio 2015 nel Poliambulatorio del quartiere Torresina a Roma. I dati rilevati sono stati elaborati mediante “Stata IC 9.2 for Mac”. RISULTATI Il campione è composto da 150 individui (età media 43 anni). Il BMI medio è 26,7. La pressione arteriosa media è 131/80 mmHg. Le abitudini alimentari confermano l’adozione di una dieta di tipo mediterraneo. All’analisi di Regressione Lineare il BMI risulta essere debolmente associato al livello di istruzione (β=-1,7; p=0,001) e al reddito (β=1,19; p=0,039). Inoltre, all’analisi di correlazione di Spearman, il BMI correla con la qualità della fonte di informazione su una corretta alimentazione (rho=0,56; p≤0,000). CONCLUSIONI I risultati di questo studio evidenziano che informazioni non sufficienti e affidabili su una corretta alimentazione correlano negativamente col rischio di essere sovrappeso e quindi di sviluppare patologie multifattoriali correlate. Il ruolo del MMG e dell’Infermiere di Comunità potrebbe essere cruciale ai fini della prevenzione.

Background The three-steps integrated program of environmental surveillance (SIPES) carried out by Hospital Hygiene Unit (HHU) in Gemelli Teaching Hospital (GTH) ensure patients and healthcare personnel safety through a safe environment, reducing risk of healthcare associated infections (HAIs). The aim of this study is to assess costs of SIPES and savings due to avoidance of HAI cases. Methods Costs for year 2014 was computed by wages of managers and technicians employees in HHU and budget for materials needed to carry out laboratory analysis. A Budget Impact Analysis (BIA), from 2011 to 2014, was performed to evaluate savings. The variables included in BIA are annual number of healthcare production processes or procedures in GTH, number of samples surveyed by HHU and the resultant nonconformity, attack rate and unit cost of HAI reported in Medline database. Results Personnel employed in HHU is composed by 7 medical doctors, 2 biologists and 6 technicians. The total amount of gross salary of employees in 2014 is E446.000 and the budget 300 European Journal of Public Health, Vol. 25, Supplement 3, 2015 for materials in 2014 is E20.000. The costs of SIPES of HHU in 2014 is E464.000. BIA results show that the SIPES performed by HHU allowed the saving of E354.676 between 2011 and 2014, taking into account only the HAIs as adverse event and considering costs of their treatment. Conclusions The results of our study suggest that a well structured environmental surveillance program, like the one implemented and pursued by HHU to ensure patients and healthcare personnel safety, may allow to save financial resources considering all adverse event such as compensations after legal cases. Further evaluations are needed to asses potential savings arising from prevention of all adverse events in hospital. Key message Targeted environmental monitoring aimed at healthcare associated infection risk assessment and management represents an effective and cost saving tool

It is estimated that by 2025 more than 20% of Europeans will be 65 or over, with a particularly rapid increase in the number of over 80s. Chronic diseases, malnutrition, weakened immune system and other health factors increase risk of foodborne illness and hazardous nutritional habits in elderly. Food safety and nutrition security are essential to promote active ageing. In order to evaluate elderly’s perceptions, practices and attitudes with respect to food safety, an articulate questionnaire was elaborated to investigate knowledge and critical aspects about unsafe food-handling practices and nutrition habits, including ethical aspects. This study was conducted in Gemelli Teaching Hospital, in Rome, Italy, between April 2014 and March 2015. Were interviewed 201 elderly 65 years old attending the Geriatrics Ward, the Outpatient Unit and the Gym of the Centre of Aging Medicine. Data were analyzed by means of frequencies and mean and standard deviations. The mean age of the sample was 74 years (SD = 7.7). The subjective perception of safe nutrition is high, in fact 64.2% of the elderly respondents think to have a balanced diet. Interviewed people get information about proper nutrition mainly from TV, papers and Internet (30%) and from health workers (34.8%) such as dietitian and nutritionist whereas only 15.4% from general practitioners. Regarding food safety and hygiene, 33.8% refers to consume expired food, even more than once a month. Between 80% and 90% of all the participants affirm to follow all the food safety practices during preparation and cooking, even though 49.3% defrost food at room temperature before preparation. These results underline the need for empowerment of elderly with respect to nutritional health and food safety. In fact, specific and targeted educational interventions for the elderly and their care-givers could be promoted in order to improve adoption of recommended food safety practices and safe nutritional habits among older adults. Key mess

Influenza vaccination coverage between HCWs is still inadequate compared with required levels and it’s mandatory to implement it with new strategies of communication We propose Forum Theatre as a possible methodology of raising awareness HCWs on this theme

The need to integrate clinical and public health training of medical students is increasingly important. Future physicians need to be able to deal with new, complex and growing public health challenges. MATERIALS AND METHODS: A literature search was performed through Pubmed to identify the conceptual reference framework. Meetings were carried out to identify the most appropriate modalities and priorities required for drafting the project, to identify the skills to be acquired by students, to decide on teaching formats and methods to assess student learning, to draw up the teaching schedule, to define the statistical methods to be used to assess student satisfaction, and to perform the statistical analysis of results. Training in hospital hygiene and environmental safety was carried out through presentation of a relevant case. After being divided into groups the students attended the three units (Environmental Microbiology, Environmental Xenobiotics, Genetic Epidemiology and Molecular Biology) of the Hygiene Section of a Public Health Institute. Training in Organization and Health Programming involved presentation of a set of indicators for the definition of objectives and assessment of health systems or services. RESULTS: The literature search led to the identification of the relevant literature. With regard to student satisfaction, 96% of those who replied to the questionnaire gave an overall positive review of the training course (at least 3 on a scale from 1 to 5). CONCLUSIONS: the overall high level of student satisfaction suggests that the proposed model may be exportable. Further developments will be the assessment of trends regarding functioning of the organizational model and perceived teaching quality.