Background Italy records very alarming levels antimicrobial resistance (AMR), so a National Actio... more Background Italy records very alarming levels antimicrobial resistance (AMR), so a National Action Plan on Antimicrobial resistance (PNCAR) was developed, adopting the AMR European Union’s recommendations based on the results of the ECDC site visit of January 2017. For achieving PNCAR objectives, it is necessary to support and harmonize the implementation of recommendations in all the different healthcare levels (regional authorities and local trusts), so the SPiNCAR project was launched to create a tool for reaching this goal. Methods We developed a framework based on a scientific literature and national and international guidelines. Firstly, we identified the major intervention areas for tackling AMR, then, for each area, we built a set of standards, both for regional authorities than for local trusts. Every standard is composed by a set of essential and additional criteria, which refer to a minimum or supplemental performance level respectively. The contents were firstly discusse...
International Journal of Environmental Research and Public Health
This study aims to estimate the economic costs of sickness absenteeism of health care workers in ... more This study aims to estimate the economic costs of sickness absenteeism of health care workers in a large Italian teaching hospital during the seasonal flu periods. A retrospective observational study was performed. The excess data of hospital’s sickness absenteeism during three seasonal influenza periods (2010/2011; 2011/2012; 2012/2013) came from a previous study. The cost of sickness absenteeism was calculated for six job categories: medical doctor, technical executive (i.e., pharmacists); nurses and allied health professionals (i.e., radiographer), other executives (i.e., engineer), non-medical support staff, and administrative staff, and for four age ranges: <39, 40–49, 50–59, and >59 years. An average of 5401 employees working each year were under study. There were over 11,100 working days/year lost associated with an influenza period in Italy, the costs associated were approximately 1.7 million euros, and the average work loss was valued at € 327/person. The major shares...
Human papillomavirus infection (HPV) affects 70-80% of female population throughout the lifetime,... more Human papillomavirus infection (HPV) affects 70-80% of female population throughout the lifetime, exposing them to the risk of developing genital warts and cervical cancer. Despite these correlated risks and the demonstrated efficacy of the vaccine, coverage rates for two-three doses are around 70% in Italy and 67% in Piemonte (below the expected 95%). Aim of the study is to investigate whether this situation is due to a lack of information and awareness among young adults. Students showed increased knowledge after the intervention and more than 90% found the 3 informative materials as sources of useful information. After the intervention students would strongly recommend HPV vaccination (OR = 3.45; p < 0.001). Higher rates of correct answers after the distribution of informative material underline the importance of knowledge delivery. Differences among the kind of material were reported; it appears that a combination of leaflet's positive features, such as clarity and intell...
Rotavirus-induced gastroenteritis (RVGE) represents the most frequent form of severe gastroenteri... more Rotavirus-induced gastroenteritis (RVGE) represents the most frequent form of severe gastroenteritis in children. In such a scenario, the availability of an efficient anti-Rotavirus (anti-RV) vaccine represents an effective prevention tool able to prevent those complications mainly linked to the moderate-severe forms of this disease, which require hospital care. The aim of the present study is to estimate the cost effectiveness of universal routine infant RV vaccination program and its budget impact on the Regional Health Service (RHS) of Piedmont, Italy, in order to evaluate the opportunity of the implementation of a national anti-Rotavirus vaccination programme. The researchers performed a cost-effectiveness analysis comparing costs and benefits of a Rotarix two-dose vaccination versus non vaccination and a budget impact analysis (BIA), complementary to the cost-effectiveness analysis. Our results show that the mass implementation of an anti-RV vaccination in Piedmont, in addition to the expected public health benefits, also allows the RHS to save a considerable amount of money within a short period of time, due to the remarkable reduction of direct health costs associated with RVGE management. In fact, as the analysis shows, a universal vaccination against RV results in money-saving for the RHS already from the 2nd year (with a vaccination coverage of 50%). During the five year period, the active and free offer of the anti-RV vaccination would determine a total saving for RHS of about € 503.000. The cost-effectiveness analysis results showed a cost-saving ICER (incremental cost-effectiveness ratio) relevant to the RHS and equal to - €12.197/QALY. In conclusion the adoption of a universal preventive strategy for all the infants in the Piedmont Region may contribute significantly towards the control of RVGE incidence, thus allowing a noteworthy saving of economic and social resources for both the RHS and the general public.
In Italy, since 2008, the surveillance of surgical site infections (SSIs) has been conducted foll... more In Italy, since 2008, the surveillance of surgical site infections (SSIs) has been conducted following ECDC recommendations, according to the protocol of the National System of Surveillance of Surgical Site Infections. In 2009, in Piedmont region, where the study was conducted, it was introduced a survey of a &amp;amp;quot;bundle&amp;amp;quot; for every patient under SSIs surveillance. The bundle includes 5 items: infection risk index calculation, preoperative shower, trichotomy, antibiotic prophylaxis, and body temperature control. The aim of this study is the evaluation of the incidence rate of the SSIs in relation to the implementation of the bundle from January 1st to December 31st, 2012. This study is an observational study (retrospective cohort). The regional surveillance system collected 3314 surgical operations during the year 2012 from 37 hospitals. The represented surgical categories were hip prosthetic surgery (HPRO: 1992 cases) and colon surgery (COLO: 1322 cases). The bundle was implemented in 1114 and 671 operations, respectively. Univariate and multivariate analysis were conducted stratifying the sample for hip surgery and colorectal surgery, with the purpose to identify an association between the implementation of the bundle and a decrease of the rate of SSIs. From the analysis, the bundle resulted as a protective factor for the infection risk in colon surgery (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.38-0.78). The main risk factors were American Society of Anesthesiologists score ≥ 3 (OR, 1.57; 95% CI, 1.10-2.24) and contamination class ≥ 3 (OR, 2.02; 95% CI, 1.37-2.97). In the hip surgery, the application of the bundle was not statistically associated to a decrease of the risk of infection. The use of surgical bundle seems to reduce significantly the SSIs rate in the colon surgery.
Aim of this study is to examine the prevalence data from different types of long-term care facili... more Aim of this study is to examine the prevalence data from different types of long-term care facilities (LTCFs); we also analyzed similarities and differences between them and national data. «Healthcare-Associated Infections and Antimicrobial Use in European Long-Term Care Facilities Project» (HALT2) is a prevalence survey of health care associated infections and antimicrobial use in European long-term care facilities. The study protocol is developed, funded and promoted by the ECDC (European Centre for Disease Prevention and Control). Data were collected on a single day from long term care facilities (LTCFs) defined as facilities in which residents need constant supervision (24 hours). Two types of questionnaires had to be completed. Point prevalence of healthcare-associated infections (HAI) and antimicrobial use (AU). 63 LTCFs in Piedmont Region participated in the HALT-2 point prevalence survey; 3,984 residents met the eligibility criteria. The crude prevalence of residents with at...
Several studies have investigated both the frequency and modality of occurrence of occupational e... more Several studies have investigated both the frequency and modality of occurrence of occupational exposure of health-care workers to blood-borne pathogens. At the moment no complete epidemiological data are available covering the hospitals of an entire Region. To describe the characteristics of mucocutaneous and percutaneous exposure to body fluids of the healthcare workers in 47 out of the 56 public hospitals (90% of a total 15,000 beds, 28,000 health-care workers full time equivalent) in Piedmont, Northern Italy (4.5 million inhabitants) over a three-year period (1999-2002), using SIROH (Studio Italiano Rischio Occupazionale da HIV) model to collect the data. 5174 percutaneous injuries (12.7/100 beds) and 1724 mucocutaneous exposure (4.1/100 beds) were recorded. Surveillance data were similar to those collected in other multi-hospital studies. The variability of rates between hospitals was high, most likely due to the amount of underreporting. The categories most at risk of percutan...
To describe the "focus group" methodological approach to hospital infection surveillanc... more To describe the "focus group" methodological approach to hospital infection surveillance and control, beginning from a quantitative analysis of laboratory data. epidemiological prevalence analysis of current data and formulation of operational proposals by means of qualitative analysis. Microbiological surveillance based on microbiology laboratory frequency data using MS Access software. Qualitative analysis with the focus group method, involving the Hospital Infection Control Committee too. In the Hospital studied, microbiological analysis highlighted a significant presence of alert microorganisms indicating problems of antibiotic resistance, mainly in some operating units. Owing to the severity of the situation, we experimented a multidisciplinary organizational procedure that allowed us to intervene. Microbiological surveillance remains a fundamental instrument for measuring the presence of alert microorganisms in hospital environments: however, in order to deal with th...
Before the measles mumps rubella (MMR) vaccination was widely offered, the epidemiologic data abo... more Before the measles mumps rubella (MMR) vaccination was widely offered, the epidemiologic data about mumps (morbidity, immunization level, vaccine coverage) were analyzed in Piedmont region (Italy). The disease had a 3- to 5-year epidemic recurrence with morbidity rate between 40 and 150/100,000; the surveillance conducted by 'sentinel' pediatricians showed that the notifications underestimated the real data by about 5- to 7-fold. The 12-year-old subjects showed an immunization level (reached by the disease or the vaccination) of about 50% and their parents tended to refuse the MMR vaccination. Only 54% of the 3- to 5-year-old children received the MMR vaccine in the second year of life and the frequency of the vaccination failure was about 10%. The strategy of vaccination should take into account this epidemiologic pattern, to program an offer adequate to reach mumps control/elimination; the strategy of our region should include the active offer in the second year of life to...
Background Italy records very alarming levels antimicrobial resistance (AMR), so a National Actio... more Background Italy records very alarming levels antimicrobial resistance (AMR), so a National Action Plan on Antimicrobial resistance (PNCAR) was developed, adopting the AMR European Union’s recommendations based on the results of the ECDC site visit of January 2017. For achieving PNCAR objectives, it is necessary to support and harmonize the implementation of recommendations in all the different healthcare levels (regional authorities and local trusts), so the SPiNCAR project was launched to create a tool for reaching this goal. Methods We developed a framework based on a scientific literature and national and international guidelines. Firstly, we identified the major intervention areas for tackling AMR, then, for each area, we built a set of standards, both for regional authorities than for local trusts. Every standard is composed by a set of essential and additional criteria, which refer to a minimum or supplemental performance level respectively. The contents were firstly discusse...
International Journal of Environmental Research and Public Health
This study aims to estimate the economic costs of sickness absenteeism of health care workers in ... more This study aims to estimate the economic costs of sickness absenteeism of health care workers in a large Italian teaching hospital during the seasonal flu periods. A retrospective observational study was performed. The excess data of hospital’s sickness absenteeism during three seasonal influenza periods (2010/2011; 2011/2012; 2012/2013) came from a previous study. The cost of sickness absenteeism was calculated for six job categories: medical doctor, technical executive (i.e., pharmacists); nurses and allied health professionals (i.e., radiographer), other executives (i.e., engineer), non-medical support staff, and administrative staff, and for four age ranges: <39, 40–49, 50–59, and >59 years. An average of 5401 employees working each year were under study. There were over 11,100 working days/year lost associated with an influenza period in Italy, the costs associated were approximately 1.7 million euros, and the average work loss was valued at € 327/person. The major shares...
Human papillomavirus infection (HPV) affects 70-80% of female population throughout the lifetime,... more Human papillomavirus infection (HPV) affects 70-80% of female population throughout the lifetime, exposing them to the risk of developing genital warts and cervical cancer. Despite these correlated risks and the demonstrated efficacy of the vaccine, coverage rates for two-three doses are around 70% in Italy and 67% in Piemonte (below the expected 95%). Aim of the study is to investigate whether this situation is due to a lack of information and awareness among young adults. Students showed increased knowledge after the intervention and more than 90% found the 3 informative materials as sources of useful information. After the intervention students would strongly recommend HPV vaccination (OR = 3.45; p < 0.001). Higher rates of correct answers after the distribution of informative material underline the importance of knowledge delivery. Differences among the kind of material were reported; it appears that a combination of leaflet's positive features, such as clarity and intell...
Rotavirus-induced gastroenteritis (RVGE) represents the most frequent form of severe gastroenteri... more Rotavirus-induced gastroenteritis (RVGE) represents the most frequent form of severe gastroenteritis in children. In such a scenario, the availability of an efficient anti-Rotavirus (anti-RV) vaccine represents an effective prevention tool able to prevent those complications mainly linked to the moderate-severe forms of this disease, which require hospital care. The aim of the present study is to estimate the cost effectiveness of universal routine infant RV vaccination program and its budget impact on the Regional Health Service (RHS) of Piedmont, Italy, in order to evaluate the opportunity of the implementation of a national anti-Rotavirus vaccination programme. The researchers performed a cost-effectiveness analysis comparing costs and benefits of a Rotarix two-dose vaccination versus non vaccination and a budget impact analysis (BIA), complementary to the cost-effectiveness analysis. Our results show that the mass implementation of an anti-RV vaccination in Piedmont, in addition to the expected public health benefits, also allows the RHS to save a considerable amount of money within a short period of time, due to the remarkable reduction of direct health costs associated with RVGE management. In fact, as the analysis shows, a universal vaccination against RV results in money-saving for the RHS already from the 2nd year (with a vaccination coverage of 50%). During the five year period, the active and free offer of the anti-RV vaccination would determine a total saving for RHS of about € 503.000. The cost-effectiveness analysis results showed a cost-saving ICER (incremental cost-effectiveness ratio) relevant to the RHS and equal to - €12.197/QALY. In conclusion the adoption of a universal preventive strategy for all the infants in the Piedmont Region may contribute significantly towards the control of RVGE incidence, thus allowing a noteworthy saving of economic and social resources for both the RHS and the general public.
In Italy, since 2008, the surveillance of surgical site infections (SSIs) has been conducted foll... more In Italy, since 2008, the surveillance of surgical site infections (SSIs) has been conducted following ECDC recommendations, according to the protocol of the National System of Surveillance of Surgical Site Infections. In 2009, in Piedmont region, where the study was conducted, it was introduced a survey of a &amp;amp;quot;bundle&amp;amp;quot; for every patient under SSIs surveillance. The bundle includes 5 items: infection risk index calculation, preoperative shower, trichotomy, antibiotic prophylaxis, and body temperature control. The aim of this study is the evaluation of the incidence rate of the SSIs in relation to the implementation of the bundle from January 1st to December 31st, 2012. This study is an observational study (retrospective cohort). The regional surveillance system collected 3314 surgical operations during the year 2012 from 37 hospitals. The represented surgical categories were hip prosthetic surgery (HPRO: 1992 cases) and colon surgery (COLO: 1322 cases). The bundle was implemented in 1114 and 671 operations, respectively. Univariate and multivariate analysis were conducted stratifying the sample for hip surgery and colorectal surgery, with the purpose to identify an association between the implementation of the bundle and a decrease of the rate of SSIs. From the analysis, the bundle resulted as a protective factor for the infection risk in colon surgery (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.38-0.78). The main risk factors were American Society of Anesthesiologists score ≥ 3 (OR, 1.57; 95% CI, 1.10-2.24) and contamination class ≥ 3 (OR, 2.02; 95% CI, 1.37-2.97). In the hip surgery, the application of the bundle was not statistically associated to a decrease of the risk of infection. The use of surgical bundle seems to reduce significantly the SSIs rate in the colon surgery.
Aim of this study is to examine the prevalence data from different types of long-term care facili... more Aim of this study is to examine the prevalence data from different types of long-term care facilities (LTCFs); we also analyzed similarities and differences between them and national data. «Healthcare-Associated Infections and Antimicrobial Use in European Long-Term Care Facilities Project» (HALT2) is a prevalence survey of health care associated infections and antimicrobial use in European long-term care facilities. The study protocol is developed, funded and promoted by the ECDC (European Centre for Disease Prevention and Control). Data were collected on a single day from long term care facilities (LTCFs) defined as facilities in which residents need constant supervision (24 hours). Two types of questionnaires had to be completed. Point prevalence of healthcare-associated infections (HAI) and antimicrobial use (AU). 63 LTCFs in Piedmont Region participated in the HALT-2 point prevalence survey; 3,984 residents met the eligibility criteria. The crude prevalence of residents with at...
Several studies have investigated both the frequency and modality of occurrence of occupational e... more Several studies have investigated both the frequency and modality of occurrence of occupational exposure of health-care workers to blood-borne pathogens. At the moment no complete epidemiological data are available covering the hospitals of an entire Region. To describe the characteristics of mucocutaneous and percutaneous exposure to body fluids of the healthcare workers in 47 out of the 56 public hospitals (90% of a total 15,000 beds, 28,000 health-care workers full time equivalent) in Piedmont, Northern Italy (4.5 million inhabitants) over a three-year period (1999-2002), using SIROH (Studio Italiano Rischio Occupazionale da HIV) model to collect the data. 5174 percutaneous injuries (12.7/100 beds) and 1724 mucocutaneous exposure (4.1/100 beds) were recorded. Surveillance data were similar to those collected in other multi-hospital studies. The variability of rates between hospitals was high, most likely due to the amount of underreporting. The categories most at risk of percutan...
To describe the "focus group" methodological approach to hospital infection surveillanc... more To describe the "focus group" methodological approach to hospital infection surveillance and control, beginning from a quantitative analysis of laboratory data. epidemiological prevalence analysis of current data and formulation of operational proposals by means of qualitative analysis. Microbiological surveillance based on microbiology laboratory frequency data using MS Access software. Qualitative analysis with the focus group method, involving the Hospital Infection Control Committee too. In the Hospital studied, microbiological analysis highlighted a significant presence of alert microorganisms indicating problems of antibiotic resistance, mainly in some operating units. Owing to the severity of the situation, we experimented a multidisciplinary organizational procedure that allowed us to intervene. Microbiological surveillance remains a fundamental instrument for measuring the presence of alert microorganisms in hospital environments: however, in order to deal with th...
Before the measles mumps rubella (MMR) vaccination was widely offered, the epidemiologic data abo... more Before the measles mumps rubella (MMR) vaccination was widely offered, the epidemiologic data about mumps (morbidity, immunization level, vaccine coverage) were analyzed in Piedmont region (Italy). The disease had a 3- to 5-year epidemic recurrence with morbidity rate between 40 and 150/100,000; the surveillance conducted by 'sentinel' pediatricians showed that the notifications underestimated the real data by about 5- to 7-fold. The 12-year-old subjects showed an immunization level (reached by the disease or the vaccination) of about 50% and their parents tended to refuse the MMR vaccination. Only 54% of the 3- to 5-year-old children received the MMR vaccine in the second year of life and the frequency of the vaccination failure was about 10%. The strategy of vaccination should take into account this epidemiologic pattern, to program an offer adequate to reach mumps control/elimination; the strategy of our region should include the active offer in the second year of life to...
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