The intertwining of healthcare-associated infections and COVID-19 in Italian intensive care units: an analysis of the SPIN-UTI project from 2006 to 2021

BACKGROUND

Although healthcare-associated infections (HAIs) pose an extraordinary burden on public health, the impact of coronavirus disease 2019 (COVID-19) is still a matter of debate.

AIM

To describe trends of HAIs in Italian intensive care units (ICUs) from 2006 to 2021, and to compare characteristics and outcomes of patients with or without COVID-19.

METHODS

We evaluated patients participating in the 'Italian Nosocomial Infections Surveillance in Intensive Care Units' (SPIN-UTI) project, who were admitted to ICUs for more than 48 h. Data regarding diagnosis, clinical conditions, therapies, treatments and outcomes of COVID-19 patients were also collected.

FINDINGS

From a total of 21,523 patients from 2006 to 2021, 3485 (16.2%) presented at least one HAI. We observed an increasing trend for both the incidence of patients with HAI and the incidence density of HAIs (P-trend <0.001). Compared with the pre-pandemic period, the incidence density of HAIs increased by about 15% in 2020-2021, with pneumoniae being the greatest contributors to this increase (P-trend <0.001). Moreover, incidence of HAIs was higher in ICUs dedicated to COVID-19 patients (P<0.001), who showed a greater risk of HAIs and death than patients without COVID-19 (P-values <0.001). Accordingly, the mortality in ICUs increased over the years and doubled during the pandemic (P-trend <0.001). Notably, co-infected patients had higher mortality (75.2%) than those with COVID-19 (66.2%) or HAI (39.9%) alone, and those without any infection (23.2%).

CONCLUSIONS

Our analysis provides useful insight into whether and how the COVID-19 pandemic influenced HAI incidence and death in Italian ICUs, highlighting the need for evaluation of the long-term effects of the pandemic.

Microbiological surveillance post-reprocessing of flexible endoscopes used in digestive endoscopy: a national study

INTRODUCTION

Microbiological surveillance of endoscopes is a safety measure for verifying the quality of reprocessing procedures and identifying contaminated devices, but duodenoscope-related outbreaks are still reported.

AIM

To assess the effectiveness of duodenoscope reprocessing procedures in Italy.

METHODS

Between December 2019 and April 2020, data obtained from microbiological surveillance post-reprocessing in 15 Italian endoscopy units were collected. Sampling was carried out after reprocessing or during storage in a cabinet. In keeping with international guidelines and the Italian position paper, the micro-organisms were classified as high-concern organisms (HCOs) and low-concern organisms (LCOs).

FINDINGS

In total, 144 samples were collected from 51 duodenoscopes. Of these, 36.81% were contaminated: 22.92% were contaminated with HCOs and 13.89% were contaminated with LCOs [2.08% with an LCO load of 11-100 colony-forming units (CFU)/device and 0.69% with an LCO load of >100 CFU/device]. The contamination rate was 27.5% in samples collected after reprocessing, 40% in samples collected during storage in a cabinet that was compliant with EN 16442:2015 (C-I), and 100% in samples collected during storage in a cabinet that was not compliant with EN 16442:2015 (NC-I). The respective HCO rates were 15.00%, 27.27% and 66.67%. Correlation between LCO contamination and storage time was demonstrated (Spearman's rho=0.3701; P=0.0026). The Olympus duodenoscope TJFQ180V demonstrated the lowest rate of contamination (29.82%), although the contamination rate was 100% for duodenoscopes stored in an NC-I cabinet.

CONCLUSION

Microbiological surveillance, along with strict adherence to reprocessing protocols, may help to detect endoscope contamination at an early stage, and reduce the risk of duodenoscope-associated infections.

Association of hospital/ICU characteristics with HAIs: findings from the SPIN-UTI project

Background

Preventing the spread of healthcare-associated infections (HAIs) in Intensive Care Units (ICUs) constitutes a priority for Public Health. In a country with decentralized healthcare system, the comparison between and within regions might represent a useful approach to identify what hospital and ICU indicators are associated with HAIs.

Methods

Using data from the SPIN-UTI (”Sorveglianza attiva Prospettica delle Infezioni Nosocomiali nelle Unità di Terapia Intensiva”) network, the present analyses aimed to identify the main hospital and ICU indicators associated with HAI incidence at national level, and to stratify the analyses between Italian regions.

Results

No associations between hospital/ICU characteristics and HAIs were evident at national level. However, ICUs in Southern Italy showed the highest incidence density of HAIs if compared with those in Central and Northern Italy (p &lt; 0.001). Stratified analyses found a positive association of incidence density of HAIs and total days in ICU in Northern Italy (β = 0.3; SE = 0.1; p = 0.002); a positive associations with ICU size (β = 1.8; SE = 0.7; p = 0.020), total days in hospital (β = 0.06; SE = 0.02; p = 0.037) and total days in ICU (β = 0.5; SE = 0.1; p = 0.006) in Center Italy; a positive association with hospital size in Southern Italy (β = 20.3; SE = 9.4; p = 0.033).

Conclusions

Although our study confirms that HAIs still represent an important issue in Italian ICUs, there is some variation between regions from Northern, Central and Southern Italy. In general, we found that HAI incidence increased with increasing number of beds in hospital and in ICU, as well as with the the increasing number of patient-days. However, further research is necessary to better understand if additional hospital and ICU characteristics could motivate the observed regional differences.

Key messages

• There is a large regional variation in the incidence of HAIs in Italian ICUs and hospitals.

• This difference that could be motivated by specific hospital and ICU characteristics.

Categorical principal component analysis to characterize patients at Intensive Care Unit admission

Background

Healthcare-associated infections (HAIs) are the most frequent complications in healthcare settings, with a major impact on adverse outcomes. Here, we aimed to identify the relationships between patients’ characteristics admitted to Intensive Care Units (ICUs).

Methods

We used data of patients included in the “Italian Nosocomial Infections Surveillance in Intensive Care Units” (SPIN-UTI) project, who stayed in ICU for more than 2 days. Using Categorical principal component analysis (CATPCA) two components of risk were assessed. Values of variance accounted for (VAF) >0.3 were accepted as the significant effect of a variable on each component. A Chronbach’s alpha >0.7 was accepted as a measure of the internal consistency of the model.

Results

A total of 22402 admissions (62% female) were included. The average age was 65.7 years (SD = 16.6). Our model explains 35.3% of the total variability, with a Cronbach's alpha value of 0.847. The visual examination of component loading plot allows to evaluate the correlation between the quantified variables and each of the two components. In particular, the first component is explained by the presence of intubation (VAF=0.826), central venous catheter (VAF=0.749), and urinary catheter (VAF=0.727), patient’s origin (VAF=0.584), antibiotic treatment (VAF=0.479), non-surgical treatment for acute coronary disease (VAF=0.375), type of admission (VAF=0.509), surgical intervention (VAF=0.419). In the second component, the variables with the greatest contribution were the SAPS II (VAF=0.660), age (VAF=0.583), type of admission (VAF=0.531), surgical intervention (VAF=0.522). Thus, the first component would represent the exposure to invasive devices and medical procedures, and the second component the severity of patients.

Conclusions

Our results proposed the usefulness of CATPCA to identify factors involved in the development of adverse outcomes, highlighting the role of exposure to invasive devices and severity of patients.

Key messages

• There are several relationships between patients clinical and personal characteristics.

• CATPCA represents a useful approach for the analytical exploitation of healthcare data.

European studies to evaluate COVID-19 vaccine effectiveness in HCWs: results from Italian hospitals

Background

Evaluating COVID-19 vaccine coverage and risk factors is useful to develop public health strategies against COVID-19 pandemic. In the framework of two studies commissioned by the European Centre for Disease Prevention and Control (ECDC) and coordinated by Epiconcept, France, we reported findings about incidence and seroprevalence among healthcare workers (HCWs) enrolled from three Italian hospitals.

Methods

From July 2021 to date, the AOUP “G. Rodolico-San Marco” (Catania), the San Gerardo Hospital (Monza) and the Policlinico Gemelli (Rome) participated in the ECDC study to measure COVID-19 vaccine effectiveness. Catania and Rome also participated to the ECDC study of nosocomial transmission. HCWs were asked to complete a weekly questionnaire to report changes in health status and professional/personal exposures. At recruitment, a nasopharyngeal swab for RT-PCR and a blood sample for serology test were collected. Moreover, HCWs were followed-up with a weekly or bimonthly nasopharyngeal or saliva swabs. Blood samples were collected every one or two months.

Results

A total of 226 HCWs was enrolled from Catania, 330 from Rome and 132 from Monza in the COVID-19 vaccine effectiveness study. As of February 2022, PCR tests performed were 2270 in Catania, 5475 in Rome and 891 in Monza sites. Moreover, the serological tests performed were 845 in Catania, 760 in Rome and 395 in Monza sites. A total of 6 SARS-CoV-2 infections were identified in Catania, 34 in Rome and 4 in Monza sites. Interestingly, the study of nosocomial transmission reported the highest incidence rate in Catania (4 per 10,000 person-day), while 0.7 per 10,000 person-day in Rome. During the study period seroprevalence declined by 17% among HWCs enrolled in Catania.

Conclusions

Our findings revealed low number of COVID-19 infections, with high COVID-19 vaccine coverage among HCWs. However, further analyses are needed to provide more robust estimates of vaccine effectiveness.

Key messages

Gender-differences in outcomes of patients in Intensive Care Unit: findings from the SPINUTI network

Background

Achieving gender equality is one of the most important Sustainable Development Goals to guarantee health and wellbeing worldwide. Here, we aimed to assess gender-differences in risk factors and outcomes among patients admitted to Italian Intensive Care Units (ICUs).

Methods

Here, we included 12,534 patients from the “Italian Nosocomial Infections Surveillance in Intensive Care Units” (SPIN-UTI) project, who stayed in ICU for more than 48 hours. Firstly, characteristics at ICU admission were compared between males and females using the Mann-Whitney U or the Chi-Squared tests. Next, we compared the probability of death between genders by applying a logistic regression analysis. Results were adjusted for covariates (i.e., age, patient's origin, trauma, non-surgical treatment for acute coronary disease, surgical intervention and presence of intubation) and reported as Odds ratio (OR) and 95% Confidence Interval (CI). Finally, the Kaplan-Meier analysis was applied to assess gender difference in survival.

Results

Compared with male patients, females were older, more likely to come from other wards or healthcare facilities and to undergo a surgical intervention (p-values&lt;0.05). By contrast, they were less likely to be intubated or traumatized and to undergo non-surgical treatment for acute coronary disease (p-values&lt;0.05). Interestingly, a higher proportion of deaths was reported in female patients (p &lt; 0.001), so that their odds of dying was 13% higher than males (OR = 1.13; 95%CI=1.00-1.28; p = 0.046) after adjusting for covariates. Accordingly, females reported lower survival in ICU than males (median= 32.0 days vs. median= 34.0 days; p &lt; 0.001).

Conclusions

Our results pointed out gender-differences in patients' characteristics at ICU admission, which resulted into a higher risk of death and lower survival among females. In a Public Health point of view, these findings underline that is still important to sustain gender equality in ICUs and other hospital wards.

Key messages

There are several gender-differences in risk factors and outcomes among patients admitted to ICUs. Gender poses per se a higher risk for death in ICU, also considering other risk factors.

Healthy diet and lifestyles assessment using a mEMA approach: protocol of the HEALTHY-UNICT study

Background

Dietary intake, physical activity and other lifestyle factors, behaviors known to change in college students, may affect long-term health outcomes. The mobile Ecological Momentary Assessment (mEMA) methods represent an innovative, detailed and valid approach to capture the complexity of food intake and behaviors and to overcome limitations of traditional dietary assessment methods. The main aim of the HEALTHY-UNICT study is to characterize heating habits, including Mediterranean Diet adherence, and others lifestyle factors, and their relationship with anthropometrics and emotions in a sample of college students of the University of Catania, using real-time mEMA methods and an innovative custom mEMA application.

Methods

Data will be collected using a mEMA tool administered via a web-based application. mEMA data collection will be carried out in two waves during the second semester of the academic year. During each wave, participants will receive prompts via the text messages to complete the surveys during four selected days, eight times per day.

Results

This abstract describes the protocol of the study. The HEALTHY-UNICT study aims to follow university students from a large university. A total of 100 students will be enrolled in the pilot phase. Expected results are the characterization of dietary behaviors, including Mediterranean diet adherence, food choices and others lifestyle factors, including smoking habits and physical activity and their relationship with anthropometrics and emotions in the sample of college students of the University of Catania.

Conclusions

The project idea should be relevant since results of the study could be useful to identify targets for the improvement of health and the promotion of healthy lifestyles in young adults. The HEALTHY-UNICT project will contribute to Sustainable Development Goals (SDGs) in the area of food and nutrition, to improve nutrition and lifestyle, through actions that combine tradition and innovation.

Key messages

The study will provide a better understanding of the food choices that college students make and insights for individual and population level prevention interventions. Findings of this study could be used to develop targeted interventions that encourage healthy food choices and healthy habit and ultimately reduce the risk of overweight and others adverse outcomes.

Risk factors for severe and fatal COVID-19 among patients admitted to an Italian hospital

Background

The epidemic of COVID-19 has spread dramatically affecting more than 140 million people and leading to more than 3 million deaths. We aimed to investigate what factors pose a risk for disease severity and death.

Methods

We prospectively included patients with laboratory-confirmed COVID-19 from San Marco Hospital (Catania, Italy), who had been admitted by Dec 31, 2020. Demographic, clinical, treatment, and laboratory data, were collected and compared between severe and non-severe patients, as well as between survivors and non-survivors. We used univariable and multivariable methods to explore the risk factors associated with disease severity and death.

Results

Overall, 463 patients were included, of whom 33.7% had severe disease and 14.0% died in hospital. Patients with severe disease were older (p &lt; 0.001) and more likely to have had heart failure (p = 0.038). With respect to the risk of death, increasing age, hypertension, diabetes, ischemic heart disease, atrial fibrillation, heart failure, chronic obstructive pulmonary disease, cancer, and chronic renal failure were more common among non-survivors than survivors (p-values&lt;0.05). In particular, a logistic regression model confirmed age (OR = 1.14; 95%CI=1.10-1.20; p &lt; 0.001) and heart failure (OR = 14.8; 95%CI=2.7-80.8; p = 0.002) as the main risk factors for death. The comparison between the first and the second waves of the epidemic did not reveal differences in demographic and clinical characteristics, however, the treatment approach has changed significantly.

Conclusions

The risk of severe and/or fatal COVID-19 was higher among older patients with comorbidities. These findings lay the foundation for prediction models that could inform shielding policies and vaccine prioritisation strategies.

Key messages

The risk of severe and fatal COVID-19 is substantially elevated among older patients with previous comorbidities. These findings are important to inform shielding policies and vaccine prioritisation strategies.

Design, protocol, and perspectives of the MADRE-REA study

Background

Unhealthy diet during pregnancy poses serious risks for both mothers and children, representing an important Public Health issue. Although Epigenetics offers a plausible explanation of the transgenerational pathway from mother to child, it is still necessary to understand if maternal epigenetic aging increases the risk for adverse outcomes in newborns. In this scenario, the “MAternal Diet, Risks and Epigenetic age during pregnancy: a Real-world Ecological momentary Assessment” (MADRE-REA) study aims to evaluate the relationship between maternal diet, epigenetic age and risk for adverse pregnancy outcomes in a mother-child cohort.

Methods

We will develop a smartphone-based ecological momentary assessment (EMA) of dietary, behavioral, physical, and sociopsychological information of 400 pregnant women recruited by the “Mamma & Bambino” cohort (Catania, Italy). Women will be asked to complete 6 waves of EMA during the 2nd and 3rd trimesters of pregnancy, and 3, 6, 9 and 12 months after delivery. Each wave consists of a 7-day assessment based on a signal-contingent approach, which prompts participants to record dietary consumption and other information. We will also examine maternal epigenetic age at recruitment and at delivery, using the DNAm PhenoAge.

Results

The novelty of the MADRE-REA study lies in the opportunity to apply a smartphone-based EMA to capture the complexity of dietary intake during and after pregnancy. Moreover, expected findings will help to understand if maternal behaviors and other exposures might affect epigenetic age, and hence if the eventual accelerated biological aging might be associated with health and disease in newborns.

Conclusions

This study could disentangle the relationship between maternal diet, epigenetic aging, and adverse outcomes, laying the foundation for future strategies to reduce the burden of disease in newborns throughout their life. The study is funded by the Italian Ministry of Health (Bando Ricerca Finalizzata 2019).

Key messages

The application of a smartphone-based tool could overcome limitations of traditional methods to assess dietary behaviors in the periconceptional period. Uncovering the relationship between maternal diet and epigenetic aging could provide the molecular basis for future strategies against adverse pregnancy outcomes.

The Clean Care Contest: promoting hand hygiene among healthcare and medical students

INTRODUCTION

Despite continuing efforts, compliance rates and knowledge of best practices in hand hygiene remain disappointing. Recognizing that conventional educational tools seem out of touch with young people and that the med and messages contents need refreshing, the Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health devised a novel approach to promote the creation of innovative educational tools for improving knowledge of, and compliance with, hand hygiene rules among healthcare and medical students.

METHODS

A contest in creating educational material on hand hygiene practices involved university students of nursing and medicine, and of other healthcare degrees. Students from the universities of the GISIO network were invited to create educational material (e.g., videos, posters, presentations, leaflets, and screensavers) to be presented by May 5th 2019 during the World Hand Hygiene Day / Save Lives: Clean Your Hands Global Annual Initiative of the World Health Organization). A local and a national winners were awarded.

RESULTS

Three different local and national contests were performed during 2016, 2017 and 2018. During the three-year period, more than 270 educational tools have been developed: 130 (48%) were judged useful for hand hygiene promotion campaigns. The most frequent projects participating in the contests were videos (39%), posters (29%), leaflets (14%), and others (18%) submitted by more than 1,500 students of nursing (40%), medicine (31%), dentistry (7%), and of other healthcare courses in 14 universities. Products were evaluated by a local committee and, subsequently, local winners represented their University in a national contest.

CONCLUSIONS

The contest provided a framework for the creation of innovative and potentially effective educational tools via an engaging approach that leveraged student creativity. Given the need to improve compliance rates, this study suggests that new ways can be advantageously explored to teach hand hygiene procedures and increase awareness of the importance of their consistent use among healthcare and medical students.

A machine learning approach to predict healthcare-associated infections at intensive care unit admission: findings from the SPIN-UTI project

BACKGROUND

Identifying patients at higher risk of healthcare-associated infections (HAIs) in intensive care units (ICUs) represents a major challenge for public health. Machine learning could improve patient risk stratification and lead to targeted infection prevention and control interventions.

AIM

To evaluate the performance of the Simplified Acute Physiology Score (SAPS) II for HAI risk prediction in ICUs, using both traditional statistical and machine learning approaches.

METHODS

Data for 7827 patients from the 'Italian Nosocomial Infections Surveillance in Intensive Care Units' project were used in this study. The Support Vector Machines (SVM) algorithm was applied to classify patients according to sex, patient origin, non-surgical treatment for acute coronary disease, surgical intervention, SAPS II at admission, presence of invasive devices, trauma, impaired immunity, and antibiotic therapy in 48 h preceding ICU admission.

FINDINGS

The performance of SAPS II for predicting HAI risk provides a receiver operating characteristic curve with an area under the curve of 0.612 (P<0.001) and accuracy of 56%. Considering SAPS II along with other characteristics at ICU admission, the SVM classifier was found to have accuracy of 88% and an AUC of 0.90 (P<0.001) for the test set. The predictive ability was lower when considering the same SVM model but with the SAPS II variable removed (accuracy 78%, AUC 0.66).

CONCLUSIONS

This study suggested that the SVM model is a useful tool for early prediction of patients at higher risk of HAIs at ICU admission.

Impact of the environment on the health: From theory to practice

The Erice 56 Charter titled "Impact of the environment on the health: from theory to practice" was unanimously approved at the end of the 56th course of the "International School of Epidemiology and Preventive Medicine G. D'Alessandro" held from 3rd to November 7, 2019 in Erice - Sicily (Italy) and promoted by the Study Group of "Environment and Health" of the Italian Society of Hygiene, Preventive Medicine and Public Health. The course, that included lectures, open discussions and guided working groups, was aimed to provide a general training on epidemiological and toxicological aspects of the environmental health impact, to be used by public health professionals for risk assessment, without forgetting the risk communications. At the end of the course 12 key points were agreed among teachers and students: they underlined the need of specific training and research, in the perspective of "One Health" and "Global Health", also facing emerging scientific and methodological issues and focusing on communication towards stakeholders. This Discussion highlight the need to improve knowledge of Health and Environment topic in all sectors of health and environmental prevention and management.

Carbapenem Consumption and Rate of carbapenemresistant gram-negative bacteria: results from the Sicilian Surveillance System

Conclusion

The results of the present study highlight the need for comprehensive strategies targeting the appropriate use of antibiotics and infection control measures.

Background

In the last decades, multidrug-resistant gram-negative bacteria have been increasing and they are involved in severe healthcare associated infections. In treating drug-resistant gram-negative bacterial infections, carbapenems are generally administered as a last choice. However, the rate of carbapenemresistant bacteria is constantly increasing the last years. The aim of the present study is to describe the relationship between the rate of carbapenem-resistant gram-negative bacteria and antibiotic consumption intensity.

Study design

In 2017, the Sicilian Region implemented a regional surveillance system to describe and analyze consumption of antibiotics in hospital settings, as well as prevalence of antibiotic resistant microorganisms.

Methods

Resistance data were retrospectively collected from routinary clinical antimicrobial susceptibility tests. Resistance rates (RRs) of carbapenems were calculated and Spearman's correlation analysis was performed to investigate the relationship between annual antibiotic consumption and rate of carbapenem resistance.

Results

In 2015, the overall prevalence of carbapenem-resistant Klebsiella pneumoniae isolates was 43.9 %, and was positively correlated with beta-lactam consumption (R=0.529, p<0.01), and with carbapenem consumption (R=0.364, p<0.05). In 2016, the overall prevalence of carbapenem-resistant Klebsiella pneumoniae isolates was 53.8 %, and was positively correlated with carbapenem antibiotic consumption (R=0.364, p<0.05). In 2017, the overall prevalence of carbapenem-resistant Klebsiella pneumoniae isolates was 58.7 %, and was significantly positively correlated with carbapenem antibiotic consumption (R=0.427, p<0.05). In 2015, the overall prevalence of carbapenem-resistant Escherichia coli isolates was 6.5 %, and was significantly positively correlated with antibiotic consumption for the ATC class J01 (i.e., antibacterial for systemic use) (R=0.402, p<0.05).

Cluster analysis identifies patients at risk of catheter-associated urinary tract infections in intensive care units: findings from the SPIN-UTI Network

BACKGROUND

Although preventive strategies have been proposed against catheter-associated urinary tract infections (CAUTIs) in intensive care units (ICUs), more efforts are needed to control the incidence rate.

AIM

To distinguish patients according to their characteristics at ICU admission, and to identify clusters of patients at higher risk for CAUTIs.

METHODS

A two-step cluster analysis was conducted on 9656 patients from the Italian Nosocomial Infections Surveillance in Intensive Care Units project.

FINDINGS

Three clusters of patients were identified. Type of admission, patient origin and administration of antibiotics had the greatest weight on the clustering model. Cluster 1 comprised more patients with a medical type of ICU admission who came from the community. Cluster 2 comprised patients who were more likely to come from other wards/hospitals, and to report administration of antibiotics 48 h before or after ICU admission. Cluster 3 was similar to Cluster 2 but was characterized by a lower percentage of patients with administration of antibiotics 48 h before or after ICU admission. Patients in Clusters 1 and 2 had a longer duration of urinary catheterization [median 7 days, interquartile range (IQR) 12 days for Cluster 1; median 7 days, IQR 11 days for Cluster 2] than patients in Cluster 3 (median 6 days, IQR 8 days; P<0.001). Interestingly, patients in Cluster 1 had a higher incidence of CAUTIs (3.5 per 100 patients) compared with patients in the other two clusters (2.5 per 100 patients in both clusters; P=0.033).

CONCLUSION

To the authors' knowledge, this is the first study to use cluster analysis to identify patients at higher risk of CAUTIs who could gain greater benefit from preventive strategies.

Klebsiella pneumoniae acquisition in ICUs: patient-based and laboratory-based surveillance

Klebsiella pneumoniae - and especially multidrug-resistant K. pneumoniae - represents a global threat for Public Health, due to its high dissemination in Intensive Care Units (ICUs) and its association with mortality. Here, we investigated the molecular epidemiology of multidrug-resistant K. pneumoniae strains in ICUs from Catania, Italy.

We used data and samples from the Italian Nosocomial Infections Surveillance in ICUs - SPIN-UTI project, which has been surveying the epidemiology and the risk of Healthcare-associated infections (HAIs) in Italian ICUs. The SPIN-UTI network adopted the ECDC protocols for patient-based HAI surveillance. In a sample of ICUs the patient-based surveillance was integrated with a laboratory-based surveillance of MDR K. pneumoniae isolates. K. pneumoniae isolates were genotyped by multilocus sequence typing (MLST), and patterns of K. pneumoniae acquisition (i.e. carriage, colonization and infection) were identified using standard definitions.

Our analysis included 155 patients who stayed in two ICUs for a total of 2254 days, from October 2016 to March 2017. Trauma patients were more likely to be infected with K. pneumoniae than other patients (OR = 5.9; 95%CI=2.4-14.8; p = 0.004). A total of 109 K. pneumoniae strains were isolated from different sites of 39 patients, which in turn were defined as 45.2% colonization, 25.8% infection, and 29% carriage. 79.3% K. pneumoniae isolates resistant to carbapenems and 100% resistant to penicillins and cephalosporins. The MLST identified two major clonal groups: the ST395 and the ST37, which represented respectively the 65.6% and the 21.3% of typed isolates.

Surveillance of colonization and infection by high-risk clones might help in implementing appropriate strategies, which are crucial to reduce the spread of K. pneumoniae in ICUs.

*Study Group AOU 'Policlinico-Vittorio Emanuele', Catania, Italy: Patrizia Bellocchi, Giacomo Castiglione, Alida Imbriani, Marinella Astuto, Giuseppa La Camera, Agata Sciacca

Key messages

Multidrug-resistant K. pneumoniae still represents a threat for Public Health in Italy and globally, due to its high dissemination in intensive care units. Surveillance of colonization and infection by high-risk clones might help in reducing the spread of Klebsiella pneumoniae.

The mediating effect of lifestyles on the association between social factors and DNA methylation

Background

Social disadvantage and unhealthy lifestyles may induce molecular changes associated with aging and age-related diseases. For instance, previous studies reported socioeconomic difference in DNA methylation, which in turn led to aberrant gene expression and genome instability. Socioeconomic status (SES) alone, however, does not completely explain this difference, and further studies are needed to unveil what factors contribute to it.

Methods

We conducted a cross-sectional study on 349 Italian women, aged 25-64 years, to assess SES differences in LINE-1 methylation level - a surrogate marker of global DNA methylation - and to examine the mediating effect of lifestyles (i.e. diet, smoking habits, physical activity, and weight status). Educational level was used as SES indicator. The adherence to Mediterranean diet (MD) was assessed by the Mediterranean Diet Score (MDS). Leukocyte LINE-1 methylation was assessed by pyrosequencing. Mediation analysis was conducted using the PROCESS macro for the SPSS software.

Results

We first observed that women with high educational level were more likely to be normal weight (p &lt; 0.001) and to adhere to MD (p = 0.018), and less likely to perform physical activity (p = 0.012) than their less educated counterpart. Moreover, age-adjusted linear regression demonstrated that LINE-1 methylation level increased with increasing educational level (β = 0.016; SE = 0.003; p &lt; 0.001). In line, mediation analysis demonstrated an indirect effect of high educational level on LINE-1 methylation through the adherence to MD (β = 0.003; 95%CI=0.001-0.006). Specifically, the mediator could account for 9.5% of the total effect. None of the other lifestyles, instead, exhibited a significant mediating effect.

Conclusions

To our knowledge, this is the first study demonstrating the mediation of diet in the relationship between SES and DNA methylation. Thus, our findings add even more value to the promotion of healthy dietary habits among social disadvantaged people.

Key messages

Social disadvantage is associated with epigenetic changes related to aging and age-related diseases. Adherence to the Mediterranean diet might mediate the association between socioeconomic status and DNA methylation.

The association of social and behavioral factors with dietary risks in adults: Evidence from the Kardiovize Brno 2030 study

BACKGROUND AND AIMS

Uncovering the main determinants of diet quality is one of the greatest challenges for Public Health, since it could guide future strategies and interventions against cardiovascular diseases (CVDs). The present cross-sectional analysis of the Kardiovize cohort evaluates the prevalence of dietary risk factors for CVDs and their association with social and behavioural characteristics in a random sample of 1536 adults (aged 25-64 years) from Brno, Czech Republic.

METHODS AND RESULTS

A face-to-face health interview guided by structured questionnaires was carried out on socio-demographic characteristics (age, sex, educational level, employment, marital status, income, and household size) and behaviours (smoking status, physical activity, and sleep habits). Twelve dietary risk factors covered by the Global Burden of Diseases comparative risk assessment framework were assessed using a Food Frequency Questionnaire. In general, we observed that the consumption of nearly all healthy foods and nutrients was suboptimal, and that it was also aggravated by high intake of foods and nutrients that constituted dietary risk factors. Moreover, we found several associations of social and behavioural characteristics with specific dietary risk factors. Particularly, being male (β = 0.466; SE = 0.079; p < 0.001), increasing household size (β = 0.130; SE = 0.047; p = 0.006), low income (β = 0.192; SE = 0.091; p = 0.035), and decreasing physical activity level (β = 0.172; SE = 0.054; p = 0.002) were associated with increasing number of dietary risk factors.

CONCLUSION

Thus, our study raises an urgent need for Public Health strategies promoting healthy eating in adulthood, which should be based on traditional and novel determinants of dietary risk.

Dietary patterns and school performance: evidence from a sample of adolescents in Sicily, Italy

BACKGROUND

Academic success in adolescence is a strong predictor of future wealth, productivity and health. While unhealthy dietary habits might be detrimental for academic outcomes, a positive association between healthy diet and school performance was found in adolescents worldwide.

STUDY DESIGN

A total of 213 adolescents (15 to 18 years old; 48% boys), attending three high schools in the urban area of Eastern Sicily, were enrolled in a cross-sectional study.

METHODS

Dietary data and informations about weekly consumption of main meals were collected administering a Food Frequency Questionnaire. The Mediterranean Diet Score and Principal Component Analysis were used to identify a priori and a posteriori dietary patterns, respectively. School performance was assessed through school marks, using the previous year as reference.

RESULTS

The Mediterranean Diet Score was weakly but positively correlated with performance in Italian, Science and Physical Education (p-values < 0.05). Similarly, the adherence to the prudent dietary pattern weakly positively correlated with marks in Mathematics. In contrast, we demonstrated a weak but significant negative correlation between adherence to the western dietary pattern and the performance in several subjects. The energy dense dietary pattern was instead negatively correlated with mark in Italian. We also showed that adolescents regularly eating all main meals have a better performance in several subjects, when compared to those who skipped at least one meal.

CONCLUSION

The promotion of healthy diet in youth should be a priority for Public Health, in order to improve adolescents' quality of life and prevent negative health and social outcomes later in life.

The impact of social determinants and lifestyles on dietary patterns during pregnancy: evidence from the "Mamma & Bambino" study

BACKGROUND

During pregnancy, maternal dietary patterns play a critical role in determining maternal and new-born health. Recent evidence highlighted the influence of either social determinants and lifestyles on the adherence to different dietary patterns.

STUDY DESIGN

In this cross-sectional analysis, we evaluated the association of social determinants and lifestyles with maternal dietary patterns in the "Mother & Child" cohort, a prospective study that enrols mother-child pairs from Catania, Italy.

METHODS

Dietary patterns were derived using Food Frequency Questionnaire and Principal Component Analysis. Logistic regression models were used to evaluate the association between socio-demographic factors (i.e., age, educational level and employment status), lifestyles (i.e., smoking status, body mass index, use of folic acid, multivitamin and multi-mineral supplements) and dietary patterns.

RESULTS

Overall, 332 women were enrolled and the following dietary patterns were derived: the "western" dietary pattern, characterized by high intake of red meat, fries, dipping sauces, salty snacks and alcoholic drinks; the second one, named "prudent", characterized by high intake of potatoes, raw and cooked vegetables, legumes, rice and soup. Multivariable analysis showed that young age, low educational level and smoking were positively associated with the adherence to the western dietary pattern. In contrast, pre-gestational body mass index was negatively associated with the adherence to the prudent dietary pattern.

CONCLUSION

Our results raise the need of strategies for promoting healthy dietary habits among women in their reproductive age, which might also help control their body weight before and during pregnancy. These strategies should be prioritized to young women of low educational level, who generally share other unhealthy behaviours.

Overview of three-year trends of antimicrobial consumption and resistance in Sicilian hospitals

Background

Antimicrobial resistance (AMR) is one of the ten threats identified by the WHO in 2019. In order to face this issue and in the framework of the National Action Plan on Antimicrobial Resistance (PNCAR) 2017-2020, the Sicilian Health Authority has implemented a surveillance system of antibiotic consumption in the hospital sector and in the community and of antibiotic resistance in the Sicilian hospitals. The aim of the present work is to report the results of three-year surveillance.

Methods

From 2015 to 2017, data on antibiotic consumption have been collected from pharmacies of participating hospitals. AMR data on seven bacterial pathogens isolated in blood and cerebrospinal fluid have been collected from hospital laboratories, using routine clinical antimicrobial susceptibility tests. Antibiotic consumption was expressed as Defined Daily Dose (DDD) per 100 patient-days. Antibiotic resistance rates (RRs) were calculated as the number of non-susceptible isolates divided by the total number of isolates multiplied by 100.

Results

The most commonly consumed antibiotics in participating hospitals were fluoroquinolones in 2015, penicillins in 2016, and beta-lactams in 2017, respectively. RRs of Klebsiella pneumoniae significantly increased for all antimicrobial classes (p &lt; 0.001), but carbapenems. By contrast, RRs of Escherichia coli resistant to third-generation cephalosporins and carbapenems showed significant decreasing trends (p &lt; 0.001).

Conclusions

The implementation of the Sicilian surveillance system provides Sicilian reference data to monitor trends and target interventions and policies for reducing the threat of AMR. Recently, using toolkits of the ECDC-EAAD initiative adapted with regional surveillance data, an educational campaign “Obiettivo Antibiotico” - https://www.obiettivoantibiotico.it/ - was designed and launched to raise awareness of prudent use of antibiotics in the general public and in healthcare professionals in Sicily.

Key messages

Inappropriate antimicrobial consumption observed in Sicilian hospitals contributes to the emergence and selection of AMR. Surveillance system of antimicrobial consumption and AMR can help identify strategies for preventing spread of multi-drug resistant microorganisms.

Dietary patterns and gestational weight gain: evidence from the “Mamma & Bambino” cohort

Background

In 2009, the Institute of Medicine (IoM) revised the guidelines on recommended gestational weight gain (GWG), taking into account pre-pregnancy body mass index (BMI) independent of age and ethnicity. However, more than half of mothers does not meet these guidelines with adverse outcomes for themselves and for newborns. Here, we used data of 232 women from the “Mamma & Bambino” cohort (Catania, Italy) to investigate the association between maternal dietary patterns, pre-pregnancy BMI and GWG.

Methods

Pregnant women were enrolled during the prenatal genetic counselling, at 4-20 gestational week. Dietary patterns were derived by food frequency questionnaire and principal component analysis. Self-reported pre-pregnancy BMI and GWG was calculated according World Health Organization and IoM guidelines, respectively.

Results

Adherence to the “western” dietary pattern - characterized by high intake of red meat, fries, dipping sauces, salty snacks and alcoholic drinks - was associated with increased GWG (β = 1.217; SE = 0.487; p = 0.013), especially among obese women (β = 7.363; SE = 1.808; p = 0.005). In contrast, adherence to the “prudent” dietary pattern - characterized by high intake of potatoes, cooked vegetables, legumes, rice and soup - was associated with reduced pre-pregnancy BMI (β=-0.651; SE = 0.308; p-trend=0.035). Interestingly, the adherence to this pattern was positively associated with GWG among underweight (β = 4.127; SE = 1.722; p = 0.048), and negatively among overweight and obese (β=-4.209; SE = 1.635; p = 0.016 and β=-7.356; SE = 2.304; p = 0.031, respectively).

Conclusions

Our findings encourage further studies to evaluate potential preventive strategies against inadequate weight gain, including the promotion of healthy dietary habits even during the periconceptional period.

Key messages

Adherence to diet rich in red meat, fries, dipping sauces, salty snacks and alcoholic drinks increases GWG, especially among obese women. Adherence to diet rich in potatoes, vegetables, legumes, rice and soup was associated with lower pre-pregnancy BMI, increased GWG among underweight, and decreased GWG among overweight/obese women.

How does education affect diet in women? A comparison between Central and Southern Europe cohorts

Background

Comparisons among European populations is useful to identify opportunities for planning nutrition strategies to reduce social inequalities in health. Our study aims to identify dietary patterns in adult women and to evaluate their association with educational level in Czech Republic and Italy, which display different health inequalities.

Methods

We performed a cross-sectional analysis of women (aged 25-64 years) with no history of severe diseases, who have been recruited in Brno (Czech Republic; n = 957) and in Catania (Italy; n = 841). Dietary patterns were derived by Food Frequency Questionnaire and Principal Component Analysis. We tested the association between educational level (low vs. high) and adherence to dietary patterns. Logistic regression models were used to assess Odds ratio (OR) and 95% confidence interval (CI), after adjusting for age, employment status, marital status, smoking status, parity, BMI, and menopause.

Results

In both cohorts, we identified the healthy and the unhealthy dietary patterns. We observed that women with high adherence to the healthy dietary pattern were less educated in Czech Republic, and more educated in Italy. After adjusting for covariates, low educational level was positively associated with adherence to the healthy dietary pattern among Czech women (OR = 2.033; 95%CI=1.301-3.176; p = 0.002), and negatively associated among Italian women (OR = 0.166; 95%CI=0.029-0.952; p = 0.044). No association was identified between educational level and the unhealthy dietary pattern.

Conclusions

In the Italian cohort, findings were consistent with the notion that healthy dietary choices are less common among low-educated groups. By contrast, in newly developed countries such as the Czech Republic, the “nutrition transition” from traditional staples to western foods might be more common in highly-educated groups, probably due to the advocacy of Western culture through mass media and commercial marketing.

Key messages

Low educational level has an opposite effect on healthy diet, exhibiting a positive association in Czech women, and a negative association in Italian women. From a broader perspective, the observed effect of education on diet quality helps explain social health inequalities in Central and Southern Europe.

A multicentre study on epidemiology and prevention of needle stick injuries among students of nursing schools

INTRODUCTION

Among the health professions with a long period of training, the students of the Nursing Bachelor's Degree are the most exposed to biological risk resulting from accidents, in particular with needles and cutting edges. The aim of the study was to estimate the frequency and the circumstances for the occurrence of needle stick injuries, as a knowledge base for targeted prevention interventions.

METHODS

The study was carried out between May and July 2017 in 11 Universities in Italy and 1 in Albania (associated with the "Tor Vergata" University of Rome). An anonymous semi-structured questionnaire was proposed to 1st (second semester), 2nd and 3rd year students of Nursing Bachelor's Degree.

RESULTS

A total of 2742 questionnaires were collected. The average age of participants was 22.9 years (median 22, range 19-60 years), 73% of whom were females. A total of 381 injuries were reported. Three hundred and sixteen students (11.8%) underwent at least 1 injury (12.7% among females, 9.7% among males); 41 students declared two or more injuries; four students did not report the number of injuries occurred. The first injury occurred, as an average, 17 days after the start of the internship (median 15 days) and, in 25% of the cases, during the first 9 days. The highest percentage of accidents occurred during the first internship (25.3% of the total) and decreased with the progress of the training path. The injuries occurred in 38% of cases during drug preparation, 24% when disposing of sharp devices, 15% while re-capping needles, 13% during blood sampling and 10% in other circumstances. In 51.2% of cases, the needle was not sterile. Among the nursing students who suffered a needle stick injury, 58.1% declared that they had performed the post-exposure prophylaxis. 96% of students stated to be vaccinated against Hepatitis B virus. Amongst the students who had their serological status checked (74%), 18% stated the antibody titre was not protective. 49.8% of students answered to have been trained in advance on the correct procedures to avoid needle stick and cutting edges injuries in each clinical ward attended, 41.2% referred that this occurred only in some wards and 10% in no ward at all.

CONCLUSION

The results of this study show a high percentage of needle stick injuries in students of the Nursing Bachelor's Degree. Therefore, there is a need for careful reflection on the most effective methods of targeted training acquisition of knowledge, skills and behavioural models useful for the exercise of the profession.

Hospital Hygiene and Infection Prevention and Control in Italy: state of the art and perspectives

Although hospital hygiene has a long history in Italy it is necessary to reflect about it because of the innovation in healthcare systems and because of the evolution due to European Union related activities. Different traditions exist in European countries about hospital hygiene and European Centre for Disease Prevention and Control (ECDC) adopted the term of "infection control and hospital hygiene" which includes all the engaged European healthcare professionals. We propose to modify hospital hygiene as "healthcare organisation hygiene" in order to focalise the attention to all care settings not only hospitals and to adopt the following definition: "all activities aimed to guarantee, in an appropriate, scientifically sound and efficient way, that structures and processes support healthcare practices in a safe comfortable and healthy environment both for patients, caregivers and healthcare workers". Hospital hygiene and its professionals, besides the long tradition, still remain a relevant pillar in guaranteeing quality and safety of healthcare in Italy.

Knowledge, experiences, and attitudes toward Mantoux test among medical and health professional students in Italy: a cross-sectional study

BACKGROUND

The World Health Organization's Action Framework for tuberculosis elimination in low-tuberculosis incidence countries includes the screening for active and latent tuberculosis in selected high-risk groups, including health care workers. In this context, medical and health profession students, exposed to nosocomial tuberculosis transmission during training and clinical rotations, are target populations for tuberculosis screening. No updated data are available on tuberculosis screening practice and knowledge of medical and health profession students in Italy.

METHODS

Within the activities Italian Study Group on Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health, we carried out a multicentre cross-sectional study to assess knowledge, attitude and practices on tuberculosis prevention and control among Medical, Dentistry, Nursing and other health professions' students. Students were enrolled in the study on a voluntary basis and were administered a previously piloted structured questionnaire. Logistic regression models were applied to explore knowledge on tuberculosis prevention by selected socio-demographic variables and University-based tuberculosis prevention practice.

RESULTS

Students of seventeen Universities across Italy participated in the study, and 58.2% of them received compulsory tuberculin skin test either at enrollment or while attending clinical practice. A total of 5,209 students filled the questionnaire. 37.7% were medicine and dentistry students (Group 1), 44.9% were nursing students (Group 2) and 17.4% were other health professions' students (Group 3). Age and gender had different distributions by groups, as well as knowledge and practice on tuberculin skin test. 84.4% of the study population (95% CI = 83.3-85.3) was aware of the existence of the tuberculin skin test, 74.4% (95% CI = 73.2-75.6) knew what is the first-level screening test for latent tuberculosis and only 22.5% (95% CI = 21.4-23.6) knew how to proceed after a positive tuberculin skin test result. Overall, knowledge on tuberculosis prevention was higher in Group 2 and lower Group 3, as compared to Group 1.

CONCLUSION

In Italy, the knowledge on tuberculosis screening among University students is generally good. To reduce some of the criticalities found among the different study courses, it would be appropriate to harmonize both the regulations on tuberculosis screening practices for admission to University courses, and the educational activities on the topic of tuberculosis, to be extended to all workers involved in health care setting.

Essential strategies in HAI prevention and control: performance assessment through the implementation of the HAI-CoSIP tool of the GISIO-SItI group. A pilot study in a sample of Italian Organizations

BACKGROUND

Healthcare-Associated Infections are a great concern for worldwide healthcare systems and represent a considerable threat to patient safety, leading to adverse clinical outcomes. A defined panel of indicators represents a key element to guide Healthcare Organizations towards identification of main gaps, implementation of effective actions and continuous improvements on Healthcare-Associated Infections prevention and control activities. A review on accreditation systems conducted by the Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene Preventive Medicine and Public Health revealed a substantial heterogeneity of implemented standards and led to the development of a core set of indicators and requirements for Healthcare-Associated Infections' prevention and control within the hospital setting. The main aim of the study was to test the feasibility of the Healthcare-Associated Infections' prevention and control within the hospital setting tool to calculate performance scores on a sample of Italian Healthcare Organizations and to identify major critical issues. The potential benefits of the possibility of future implementation of the tool within Institutional Accreditation Programs is discussed.

STUDY DESIGN

Cross sectional pilot survey.

METHODS

The Healthcare-Associated Infections' prevention and control within the hospital setting included 96 criteria and 20 key areas including an area for outcomes indicators. For applicable criteria, standards fulfilment was evaluated according to a 4 point Likert scale. A composite score was calculated for each Healthcare Organization and five performance levels were identified. Data were further analysed by computing performance scores at the level of each area and requirement.

RESULTS

20 Healthcare Organizations agreed to take part in this pilot study including two rehabilitative Healthcare Organizations. Among the whole sample a mean of 12.20% of requirements resulted not fulfilled, leaving space for further improvements. Critical areas were easily identified and the instrument was able to capture substantial differences between Healthcare Organizations. Only a few number of standards resulted "Not Applicable" (Mean = 4.71%) and most of them regarded Rehabilitative Healthcare Organizations. Mean composite performance index resulted 74.06% (SD = 16.96, range 36.30 - 94.27%); area of outcome indicators obtained a mean score of 56.17.

CONCLUSION

The Healthcare-Associated Infections' prevention and control within the hospital setting resulted an useful tool to assess Healthcare Organizations' performance in the field of Healthcare-Associated Infections prevention and control and to identify necessary actions for further improvements. The distribution of total scores by Healthcare Organizations showed a high heterogeneity. Implementation of the Healthcare-Associated Infections' prevention and control within the hospital setting tool as an institutional accreditation tool may help to drive the required harmonization at a national level of Healthcare-Associated Infections management and control strategies and overcome current substantial regional differences.

Epidemiology of intensive care unit-acquired sepsis in Italy: results of the SPIN-UTI network

BACKGROUND

Sepsis is the major cause of mortality from any infectious disease worldwide. Sepsis may be the result of a healthcare associated infection (HAI): the most frequent adverse events during care delivery especially in Intensive Care Units (ICUs). The main aim of the present study was to describe the epidemiology of ICU-acquired sepsis and related outcomes among patients enrolled in the framework of the Italian Nosocomial Infections Surveillance in ICUs - SPIN-UTI project.

STUDY DESIGN

Prospective multicenter study.

METHODS

The SPIN-UTI network adopted the European protocols for patient-based HAI surveillance.

RESULTS

During the five editions of the SPIN-UTI project, from 2008 to 2017, 47.0% of HAIs has led to sepsis in 832 patients. Overall, 57.0% episodes were classified as sepsis, 20.5% as severe sepsis and 22.5% as septic shock. The most common isolated microorganisms from sepsis episodes were Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa. The case fatality rate increased with the severity of sepsis and the mean length of ICU-stay was significantly higher in patients with ICU-acquired sepsis than in patients without.

CONCLUSION

Our study provides evidence that ICU-acquired sepsis occurs frequently in Italian ICU patients and is associated with a high case fatality rate and increased length of stay. However, in order to explain these findings further analyses are needed in this population of ICU patients.

The effectiveness of educational interventions in university training on hospital hygiene: results of action research

BACKGROUND

The Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health promoted and conducted a study on teaching hospital hygiene, with particular reference to the prevention and control of healthcare-associated infections, with the aim of developing effective educational material starting from the results collected.

MATERIAL AND METHODS

First of all, a survey was carried out, targeting lecturers in hospital hygiene, with the purpose of investigating their perceptions regarding this issue. The available scientific literature was also reviewed in order to identify effective educational/teaching strategies for the prevention of healthcare-associated infections, so that valid training interventions could be subsequently developed. Finally, a trial-training intervention was implemented, and specific audio-visual teaching material was also tested.

RESULTS

The overall response rate to the survey was 42%, with good country-wide representativeness. The level of awareness of hospital hygiene issues by students resulted higher among trainee nurses (65%) than among medical students (44%). The teaching staff identified alternative educational methodologies to substitute the classical lecture (e.g.: case discussions) and, in most cases, the alternative solution appeared to be preferable. The teaching of hospital hygiene was better integrated with other disciplines and professional training activities in the degree courses for nurses than in those for doctors; the total number of hours assigned to such teaching was variable. The literature review highlighted that various educational approaches are used. The most common are presentations or lectures, but videos, posters, questionnaires and e-learning strategies are also used. Combining different instruments when designing an educational programme has proven to be an effective strategy. The training activity tested was positively evaluated by the participants; the possibility of multidisciplinary exchange of knowledge was particularly appreciated.

CONCLUSION

Having considered the issue of teaching hospital hygiene from the points of view of the different protagonists involved (educators and students), this enabled us to develop useful training material and a proposal for a shared educational intervention. The subject of hospital hygiene, in particular the one related to the prevention of healthcare-associated infections, is addressed in various courses and with different modalities; it is, therefore, important to standardize course contents and teaching methods, in order to facilitate multidisciplinary debate, especially starting from case studies.

The commitment of the GISIO-SItI to contrast Healthcare-Associated Infections and the experience of prevalence studies in Sicily

Surveillance of Healthcare-Associated Infections (HAIs) is essential to improve the quality of health services. The aim of this paper is to report the commitment of the Italian Study Group of Hospital Hygiene (GISIO) of the Italian Society of Hygiene, Preventive Medicine and Public Health (SItI) describing some experiences to contrast HAIs and antimicrobial resistance. Particularly, the commitment to contrast HAIs in intensive care with the SPIN-UTI project - Italian Nosocomial Infections Surveillance in ICUs, and in surgery with the ISCHIA project - Infections of Surgical Site in Arthroplasty Interventions - were described. Furthermore, some activities conducted in Sicily using repeated prevalence studies were reported. The experiences reported confirmed that surveillance is essential to provide health services with information, guidance and tools to manage effectively the risk of HAI and antimicrobial resistance and to monitor the level of achievement of control programmes.

Hygiene and Public Health courses in Biology curricula: the Italian scenario and the best examples from all over the world

Different longstanding and emerging challenges for public health have been identified including population ageing, migration, infectious and non-communicable diseases, the environment and climatic changes, increasing risks of misinformation and chronic underinvestment. The multi- and inter-disciplinary public health approach - including biology, epidemiology, biostatistics, anthropology and public policy - raises the need to train experienced professionals in different fields. The education on these matters is fundamental to ensure the human well-being. In the last years, education in schools of public health is changing in response to new evidence-based knowledge, opportunities for improvement and scientific discoveries. In this manuscript the current scenario of teaching Hygiene in all the Italian degree courses in Biology were reviewed and summarized and the most excellent examples of academic training offer of Public Health for Biologists worldwide were provided and discussed as a source of inspiration for novel Masters and PhD degree programmes in Italy.

Procedures in endoscope reprocessing and monitoring: an Italian survey

BACKGROUND

The high diffusion of endoscopes worldwide and the need for effective reprocessing methods requested the development of guidelines and implementation of surveillance procedures at local level.

STUDY DESIGN

In order to collect data on everyday's practice and adherence to available guidelines, endoscopy units from different public institutions were surveyed using a dedicated questionnaire.

METHODS

Between July and November 2015 a survey was carried in 12 main hospitals from 10 different Italian regions, involving 22 endoscopy units. The state of the art of national and international guidelines was investigated to compare the protocols adopted at local level.

RESULTS

In all the surveyed hospitals, the reprocessing activity is based on pre-established protocols in adherence with principal guidelines. Enzymatic detergents, which are recommended by the international guidelines, are used in 55.6% of units and peracetic acid is currently the most widely used chemical disinfectant. Discrepancies were observed in the application of periodic quality controls.

CONCLUSION

Updated guidelines are generally applied in reprocessing practice. Quality controls may represent a critical issue to improve effectiveness and surveillance. The whole of acquired data can promote a positive trend towards the application of best practices.

Association between eating time interval and frequency with ideal cardiovascular health: Results from a random sample Czech urban population

BACKGROUND AND AIMS

The frequency and timing of meals may affect cardiovascular health (CVH) outcomes, but large-scale epidemiological studies are lacking. The aim of this study was to understand the relationship between eating time interval and frequency, and measures of ideal CVH in the Kardiovize Brno cohort study, a random urban sample population in Central Europe.

METHODS AND RESULTS

1659 members of the Kardiovize Brno 2030 cohort were included in a cross-sectional study (mean age = 46.86 years; 44.6% male). Exposure variables were eating time interval and frequency, and skipping meals. Primary outcomes were indices of CVH, including body mass index, diet, physical activity, smoking, blood pressure, glucose and cholesterol, and the composite CVH score. Cluster analysis and binary logistic regression analysis were used to evaluate eating habits and the association between variables. After adjustment for well-known risk factors, subjects who skipped breakfast or the afternoon snack had a higher risk of poor CVH (OR = 1.613; 95%CI = 1.121-2.320; p = 0.010; OR = 1.409; 95%CI = 1.110-1.788; p = 0.005, respectively). Moreover, we identified three clusters of individuals based on eating habits; from cluster 1 to cluster 3, eating time interval and frequency increased and this was associated with increases in CVH score from 8.70 (SEM = 0.10) in cluster 1, and 9.06 (SEM = 0.08) in cluster 2 to 9.42 (SEM = 0.09) in cluster 3 (p-trend = 0.019).

CONCLUSIONS

Our findings suggest that skipping breakfast or the afternoon snack are risk factors for poor CVH, while higher eating time interval and frequency may promote ideal CVH.

Definition of criteria and indicators for the prevention of Healthcare-Associated Infections (HAIs) in hospitals for the purposes of Italian institutional accreditation and performance monitoring

BACKGROUND

Healthcare-associated infections (HAIs) are an important issue in terms of quality of care. HAIs impact patient safety by contributing to higher rates of preventable mortality and prolonged hospitalizations. In Italy, analysis of the currently available accreditation systems shows a substantial heterogeneity of approaches for the prevention and surveillance of HAIs in hospitals. The aim of the present study is to develop and propose the use of a synthetic assessment tool that could be implemented homogenously throughout the nation.

METHODS

An analysis of nine international and of the 21 Italian regional accreditation systems was conducted in order to identify requirements and indicators implemented for HAI prevention and control. Two relevant reviews on this topic were further analyzed to identify additional evidence-based criteria. The project team evaluated all the requirements and indicators with consensus meeting methodology, then those applicable to the Italian context were grouped into a set of "focus areas".

RESULTS

The analysis of international systems and Italian regional accreditation manuals led to the identification respectively of 19 and 14 main requirements, with relevant heterogeneity in their application. Additional evidence-based criteria were included from the reviews analysis. From the consensus among the project team members all the standards were compared and 20 different thematic areas were identified, with a total of 96 requirements and indicators for preventing and monitoring HAIs.

CONCLUSIONS

The study reveals a great heterogeneity in the definition of accreditation criteria between the Italian regions. The introduction of a uniform, synthetic assessment instrument, based on the review of national and international standards, may serve as a self-assessment tool to evaluate the achievement of a minimum standards set for HAIs prevention and control in healthcare facilities. This may be used as an assessment tool by the Italian institutional accreditation system, also useful to reduce regional disparities.

Risk of surgical site infections following hip and knee arthroplasty: results of the ISChIA-GISIO study

BACKGROUND

Surgical Site Infection (SSI) is one of the major complications following insertion of hip or knee prosthesis. The aim of the present study was to describe rates of SSIs and associated risk factors during hip and knee prosthesis procedures in Italian hospitals.

METHODS

Italian hospitals were invited to join the ISChIA (Surgical Site Infections in Arthroplasty Surgery) project and participated in the study on a voluntary basis. SSI surveillance was performed according to the Hospitals in Europe Link for Infection Control through Surveillance (HELICS) -SSI protocol. The study population consisted of all patients who had a prosthetic knee or hip joint replacement between March 2010 and February 2011. Only elective operations were include.

RESULTS

A total of 14 hospitals and 1285 surgical procedures were included. SSI cumulative incidence was 1.3 per 100 hip and 2.4 per 100 knee surgical procedures; a significant positive trend of SSI incidences was observed with increasing SSI risk index. In multivariate analysis, considering hip procedures, the single independent risk factor associated to SSI was operation length (RR: 4.54; 95%CI: 1.06-19.48). For knee procedures, no significant risk factor was identified.

CONCLUSIONS

In the present study, SSI cumulative incidence was in the range of European data. However, a larger number of operations is needed to better estimate SSI rates. A second edition of the ISChIA project has been already conducted and results of the two surveys will provide new insight to further our knowledge for infection control.

Environmental health risk communication in the case "Terra dei Fuochi": content analysis of online newspaper articles

BACKGROUND

The aim of the study is to evaluate the way in which information is conveyed by one of the major national newspapers, in its online version, Repubblica.it, about health risks associated with the "Terra dei Fuochi".

METHODS

A retrospective systematic search in the online newspaper database was carried out for articles published from 1st January through 13th May 2014. The keyword used was "Terra dei Fuochi". A corpus, containing all articles included, was built in order to perform content analysis and text-mining using the T-LAB software, together with a critical interpretation. The co-occurrence analysis was performed using the keywords: environment, prevention, waste , risk and science.

RESULTS

A total of 211 articles were retrieved, but only 188 articles met the inclusion criteria and were included in the analysis. The section of publication with the largest number of articles was represented by Repubblica Napoli edition with 50% of articles, whereas, only 2% of articles were included in the Environment section, and no article has been placed in the Health section. The most occurring lemmas were: waste, Naples, President, environmental - environment and health. Lemmas as disaster, drama, alarm and fear occur with medium frequency. Among the lemmas with less occurrence there were: remediation, cancer, people, information and recycle. However, terms as communication and risk management were absent.

CONCLUSIONS

This study contributes to our understanding of how environmental health risks associated with the "Terra dei Fuochi" issue are presented by the newspapers to the public, which has implications for how the public may learn about risk management information.