Hospital In Central Italy Research Articles

Prevalence of Sars-Cov-2 Infection in Health Workers (HWs) and Diagnostic Test Performance: The Experience of a Teaching Hospital in Central Italy

(1) Background: Health workers (HWs) are at high risk of acquiring SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infections. Therefore, health authorities further recommend screening strategies for SARS-CoV-2 infection in exposed or high-risk HWs. Nevertheless, to date, the best/optimal method to screen HWs for SARS-CoV-2 infection is still under debate, and data on the prevalence of SARS-CoV-2 infection in HWs are still scarce. The present study aims to assess the SARS-CoV-2 infection rate amongst HWs in a teaching hospital in Central Italy and the diagnostic performance of SARS-CoV-2 serology (index test) in comparison with the SARS-CoV-2 RNA PCR assay (reference standard). (2) Methods: A cross-sectional study on the retrospective data of HWs tested for SARS-CoV-2 by RNA-RT-PCR on nasopharyngeal swabs and by an IgM/IgG serology assay on venous blood samples, irrespective of exposure and/or symptoms, was carried out. (3) Results: A total of 2057 HWs (median age 46, 19–69 years, females 60.2%) were assessed by the RNA RT-PCR assay and 58 (2.7%) tested positive for SARS-CoV-2 infection. Compared with negative HWs, SARS-CoV-2-positives were younger (mean age 41.7 versus 45.2, p < 0.01; 50% versus 31% under or equal to 40 years old, p < 0.002) and had a shorter duration of employment (64 versus 125 months, p = 0.02). Exposure to SARS-CoV-2 was more frequent in positive HWs than in negatives (55.2% versus 27.5%, p < 0.0001). In 44.8% of positive HWs, no exposure was traced. None of the positive HWs had a fatal outcome, none of them had acute respiratory distress syndrome, and only one required hospitalization for mild/moderate pneumonia. In 1084 (51.2%) HWs, nasopharyngeal swabs and an IgM/IgG serology assay were performed. With regard to IgM serology, sensitivity was 0% at a specificity of 98.99% (positive predictive value, PPV 0%, negative predictive value, NPV 99.2%). Concerning IgG serology and irrespective of the time interval between nasopharyngeal swab and serology, sensitivity was 50% at a specificity of 99.1% (PPV 28.6%, NPV 99.6%). IgG serology showed a higher diagnostic performance when performed at least two weeks after testing SARS-CoV-2-positive at the RNA RT-PCR assay by a nasopharyngeal swab. (4) Conclusions: Our experience in Central Italy demonstrated a low prevalence of SARS-CoV-2 infection amongst HWs, but higher than in the general population. Nearly half of the positive HWs reported no previous exposure to SARS-CoV-2-infected subjects and were diagnosed thanks to the proactive screening strategy implemented. IgG serology seems useful when performed at least two weeks after an RNA RT-PCR assay. IgM serology does not seem to be a useful test for the diagnosis of active SARS-CoV-2 infection. High awareness of SARS-CoV-2 infection is mandatory for all people, but especially for HWs, irrespective of symptoms, to safeguard their health and that of patients.

A cross-sectional study on the prevalence and incidence of pressure ulcers in an Italian University Hospital-Umbria Region

The aim of the present study was to assess the prevalence and incidence of pressure ulcers (PUs) in patients hospitalized in a University Hospital in central Italy. We carried out a prevalence and incidence study on PUs and an additional prevalence estimate of PUs was also produced ten days after the first assessment. All data were explored by descriptive statistics, the Chi-square test and a multivariate analysis. The prevalence of pressure ulcers was of 6,5%, while it increased to 9,9% at the second assessment ten days after the first measurement. Prevalence was statistically significant and increased with the age of inpatients (p=0,004) and was correlated to the origin of the patients (p=0,002). The incidence of PUs ten days after hospital admittance was of 3,6%. Ulcers are more frequently observed in the general medicine rather than in the surgery and intensive care units. Results showed that there exists a meaningful relationship between increased risk (Braden 16) and the presence of PUs, with an OR of 1,40 (95% CI 1,03-1,62) in high risk patients (Braden -12) and with an OR of 1,61 (95% CI 1,06-2,42) in very high or prohibitive risk patients (Braden 13-16). The most affected areas are the sacrum, the heels and the ankles. Mobilization plans were scarcely available, or do not described. The obtained data confirmed the difficulty to measure whether PU prevention practices are being carried out in compliance with the set guidelines presently in use in all the University Hospital Units. There is still a very limited use of available risk assessment tools for predicting PU risk and mobilization plans are still poorly documented. A monitoring and follow-up strategy should be implemented to better understand prevalence and incidence rates.

Nurses' and physicians' opinions on end-of-life: a secondary analysis from an Italian cross-sectional study.

In daily clinical practice, healthcare workers face end-of-life issues, such as futility, which is generally defined as the provision of treatments that do not produce any meaningful benefit for patients. To investigate the end-of-life issues according to Italian nurses' and physicians' opinions and to detect any differences between them, a secondary analysis of existing data from a cross-sectional study was conducted. A validated questionnaire was used involving 351 nurses and 128 physicians from four hospitals in Central Italy. Regarding the definition of futility, nurses mainly focused on agony, suffering, and risks, while physicians paid more attention to the hope of healing. Nevertheless, both were distressed by different aspects of the treatments; in particular, nurses by the 'invasiveness of the treatments' and physicians by the 'over-medicalization of death'. Instead, nurses and physicians similarly recognized patients' right to seek to anticipate the end of life when they are terminally-ill and to express freely their desire not to be revived. The description of experiences and opinions of health professionals could represent a valid basis to develop a 'regulatory system' aimed to guide and support daily clinical and nursing activities.

NANDA-I, NIC, and NOC taxonomies, patients' satisfaction, and nurses' perception of the work environment: an Italian cross-sectional pilot study.

Background and aim of the work:Structured nursing care planning, patients’ satisfaction with care, nurses’ job satisfaction, and the characteristics of the work environment may influence each other and impact on the quality of hospital care. This study aimed at investigating the differences in nurses’ perception of the work environment and patients’ satisfaction with care, between two groups of hospital wards that used NANDA-I, NIC, and NOC taxonomies or not in the daily practice.Methods:A pilot cross-sectional study was conducted involving nurses employed in eight wards of a teaching hospital in central Italy and patients hospitalized in these wards. The ‘Nursing Work Index Revised’ and the ‘Patient Satisfaction Scale’ were used to investigate nurses’ perception of the work environment and patients’ satisfaction with care, respectively.Results:Significant better perceptions of both the constructs were highlighted in those wards that used nursing taxonomies.Conclusions:The application of a healthcare model based on the nursing process methodology should be empowered in the hospital settings, since it can influence the quality of the environment and patients’ satisfaction with care. (www.actabiomedica.it)

Characterisation of candidemia in patients with recent surgery: A 7-year experience.

Candidemia can complicate major surgical procedures. However, literature data are scanty on this topic. In this study, we evaluated the epidemiology, clinical and microbiologic characteristics and outcome of candidemia in adult patients with recent surgery hospitalised in a single University Hospital in Central Italy from 2010 to 2016. Of the 304 episodes of candidemia, 160 (53%) occurred in surgical patients (SPs) while the remaining 144 (47%) in patients without history of recent surgery (non-SPs). Although either underlying chronic comorbidities (ie haematological malignancies, neurological and gastrointestinal diseases) or acute complications (ie pneumonia and septic shock) were less likely to occur in SPs than in non-SPs, 30-day mortality did not differ between groups being 38% and 42%, respectively. The specific risk factors significantly more common in SPs who died within 30days were as follows: male gender, older age, being hospitalised in ICU rather than in other wards, having a higher Charlson's score, undergoing previous invasive procedures, haemodialysis, the presence of pneumonia, septic shock, acute kidney failure and the type of surgery. In particular, either gastrointestinal or cardiovascular surgeries were characterised by the highest mortality rates. Multivariate analysis showed that the occurrence of septic shock (HR 10.3131 [CI95% 1.176-90.466; P=.035] and ICU stay (HR 2.016 [CI95% 1.178-3.448; P=.011] was independently associated with higher mortality in SPs. Overall, these data show that candidemia in SPs is characterised by significant mortality and distinctive features.

Carbapenemases and efflux pumps in clinical Acinetobacter baumannii: biomolecular characterization of multi-drug resistant isolates from a hospital in Central Italy

Purpose: Multi-drug resistant (MDR) Acinetobacter baumannii is increasingly responsible of hospital-acquired infections, mainly in intensive care units (ICUs). Aims of this study were to assess antibiotic resistance phenotypes and clonal relationships in A. baumannii isolates from hospital setting, and to evaluate circulating carbapenemases (blaKPC, blaGES, blaSHV, blaIMP, blaVIM, blaNDM, blaGIM, blaAmpC, blaOXA-23, blaOXA-24, blaOXA-51, blaOXA-58). Prevalence of multi-drug efflux pumps encoding genes (adeB, adeG, adeJ, abeS, craA, abeM) and their negative regulator (soxR) was also determined. Methods & Materials: Clinical A.baumannii (n = 24) were collected from “A.Cardarelli” hospital (95.8% from ICU), in Molise Region (Central Italy). The Minimum Inhibitory Concentration (MIC) was assessed for 20 antibiotics by BD Phoenix™, including carbapenems (imipenem and meropenem). Molecular typing was performed through Pulsed-Field Gel Electrophoresis (PFGE) with ApaI and AscI enzymes, while PCR assays were carried out to detect carbapenemases and multi-drug efflux pumps encoding genes. Results: A.baumannii strains were resistant to almost all antibiotics, including carbapenems. The combined ApaI/AscI dendrogram analysis revealed four clusters and seven pulsotypes at 95% similarity (Simpson Index: D = 84.0%). Among resistance genes, all strains harboured blaOXA-23, blaOXA-51 and blaAmpC, and 33.3% (n = 8) blaVIM, while blaKPC, blaGES, blaSHV, blaIMP, blaNDM, blaGIM, blaOXA-24, and blaOXA-58 were never detected. On multi-drug resistance mediated by efflux pumps, all isolates were adeB, adeG, adeJ, soxR and abeS positive, while abeM and craA were not found. Conclusion: The study findings highlight the circulation of MDR A.baumannii in hospital ICU, underlining the urgent need of strategies for limiting their spread. Molecular epidemiology showed that isolates are characterized by a remarkable resistance to carbapenems, explained by the highest prevalence of blaOXA-23 and blaOXA-51, in line with other Italian studies. Interestingly, detection of blaVIM suggest an important increase of this carbapenemase circulation, which is occasionally found in A.baumannii in Italy. The lack of other resistance genes confirm their very low occurrence, according to nationwide distribution. The value of D confirms the need of integrate other typing methods with PFGE. Further studies are required to evaluate clonal diversity through Sequence Types distribution and on the efflux pumps role in resistance mechanisms by transcriptional level analysis.

A low cost, volunteer-based program to prepare children to undergo magnetic resonance imaging without sedation

ABSTRACTBackground: Magnetic resonance imaging (MRI) is a common medical procedure that often causes increased anxiety and distress in children due to the procedure conditions. For this reason, children are commonly sedated or anaesthetized during MRI, and this adds an additional risk.Objective: An MRI intervention practice was introduced in a local public hospital in central Italy to prepare children to undergo MRI without sedation. The program was initially set up by university staff and was carried out by a local organization after training.Materials and methods: The program was based on a bioecological approach and took place between 2008 and 2017 in a playroom, using role-play, socio-emotional support, teaching of coping skills, behavioral modeling and desensitization. Data were collected retrospectively with respect to age, gender, duration of scans and scan quality, which was assessed by a radiologist using a Likert scale.Results: Sixty-six children were included in the program (age 3–14 y; mean age 7.5 y; standard deviation, 2.55; 63% males). All of the children succeeded in completing the preparation, and 61 (92.4%) achieved a clinically diagnostic MRI without sedation. Image quality was in line with similar studies. There was no effect of exam duration on image quality and no correlation between age and image quality.Conclusion: The MRI preparation program enabled children to cope with the procedure without sedation. This program represents an example of the collaboration between educators, practitioners, and volunteers, jointly taking an active role in supporting children during a medical procedure.

High Rate of Ceftobiprole Resistance among Clinical Methicillin-Resistant Staphylococcus aureus Isolates from a Hospital in Central Italy.

Ceftobiprole is a fifth-generation cephalosporin with activity against methicillin-resistant Staphylococcus aureus (MRSA). One-year surveillance at the Regional Hospital of Ancona (Italy) disclosed a 12% ceftobiprole resistance rate (12/102 isolates; MIC, ≥4 mg/liter). Epidemiological characterization demonstrated that the resistant isolates all belonged to different clones. Penicillin-binding protein (PBP) analysis showed substitutions in all PBPs and a novel insertion in PBP2a. The mecB and mecC genes were not detected. Ceftobiprole susceptibility screening is essential to avoid therapeutic failure and the spread of ceftobiprole-resistant strains.

Molecular Diagnosis of Malaria Infection: A Survey in a Hospital in Central Italy

Molecular Diagnosis of Malaria Infection: A Survey in a Hospital in Central Italy

Violating organizational and social norms in the workplace: a correlational study in the nursing context.

The aim of this study was to examine, in a sample of nurses, the relationships between the organizational context variables (i.e., workload, interpersonal conflicts, organizational constraints), the burnout, the moral disengagement, and the counterproductive work behaviors (CWB), within their clinical work settings. A descriptive, correlational study was conducted in a sample of 347 nurses working in different clinical settings in a big university hospital in Central Italy. A self-report questionnaire was used for data collection, using several scales to assess different variables related to the organisational context, the burnout, the interpersonal strain, the moral disengagement, and the CWB. The clinical context was found to influence nurses' organizational wellbeing, which in turn was found to foster CWB. Nurses working in outpatients settings and in day hospitals were those who reported the lowest CWB, in comparison with nurses working in the Emergency Department and in the General Medicine Units. Findings of this study are important for nursing professional chiefs and for any professional involved in the promotion of workers' wellbeing. Our study findings highlight how the clinical work setting and the organizational context variables can lead to CWB. Researchers and managers should keep these aspects in high consideration due to their influence on the quality of the care delivered.

May the drain be a way in for microbes in surgical infections?

Surgical site infection (SSI) is among the most frequent hospital-acquired infections occurring in surgical patients and leads to increased morbidity, mortality, and costs. We aimed to identify risk factors for SSI in patients undergoing surgical procedures, with a particular attention to the use of drains. This study includes all patients undergoing abdominal surgical procedures in 2 surgical wards in a teaching hospital in central Italy. Collected data included patient's demographic and clinical characteristics, procedure characteristics, administration of perioperative antibiotic prophylaxis, and microorganism isolated. The outcome of interest was SSI. A total of 872 abdominal surgery procedures were surveyed during the study period. Drains were placed in 37.0% of cases. SSI rate was 6.4% globally and 13.6% among the patients with drains, versus 2.4% in those without a drain (P < .001). In 72.1% of cases antibiotic prophylaxis was administered. The logistic regression analysis (P < .001) shown insertion of a drain (odds ratio [OR], 5.14; 95% confidence interval [CI], 2.63-10.08), prolonged surgery (OR, 1.98; 95% CI, 1.09-3.59), and American Society of Anesthesiologists score equal to 3 (OR, 6.13; 95% CI, 2.33-16.11) as independent risk factors for SSI, whereas antibiotic prophylaxis was protective (OR, 0.53; 95% CI, 0.29-0.99). This study revealed surgical drains as a risk factor for SSI, pointing out the need of a clearer understanding of drain role in the dynamics of SSI occurrence, with the purpose of decreasing infection risk through targeted preventive interventions.

Epidemiology, clinical characteristics, and outcome of candidemia in a tertiary referral center in Italy from 2010 to 2014.

We evaluated the epidemiology, clinical characteristics and outcome of candidemia in a single institution from 2010 to 2014. A retrospective observational study of all cases of candidemia was carried out at a University Hospital in Central Italy including five intensive care units (ICUs), 11 medical and 11 surgical wards. Data regarding demographic characteristics and clinical risk factors were collected from the patient's medical records. Antifungal susceptibility testing was performed and MIC results were interpreted according to species-specific clinical breakpoints. A total of 270 episodes of candidemia were identified. Overall incidence rate was 1.5 episodes/1000 hospital admissions. Although Candida albicans represented the most commonly isolated species, its percentage significantly decreased from 68 to 48 % (p = 0.040). The overall 30-day mortality was 35 %. The variables independently associated with a significant higher risk of mortality were: older age; being hospitalized in ICU or in medical wards vs surgical wards; being infected with C. albicans vs other species; the occurrence of septic shock, pneumonia and acute renal failure; the presence of a solid organ tumor or a chronic pulmonary disease. Conversely, an appropriate treatment was confirmed to be significantly associated with a lower risk of mortality. The overall resistance was low and it was noted only among triazoles. Our study shows that candidemia is a significant source of morbidity and mortality. The identification of risk factors associated with mortality along with the knowledge of local susceptibility may lead to a better management in terms of preventive and therapeutic measures.

Towards a smoke-free hospital: how the smoking status of health professionals influences their knowledge, attitude and clinical activity. Results from a hospital in central Italy.

In Italy, the prevalence of smoking among health professionals is higher than in the general population and this might hamper their role in the promotion of health. This study aimed to investigate how the smoking status of healthcare professionals might influence knowledge, attitudes and clinical practice in a hospital in central Italy in order to enforce effective tobacco control measures. Physicians and professionals of the hospital were asked to complete an anonymous questionnaire which yielded epidemiological and environmental information on knowledge, attitude, clinical practice and quality of the hospital environments, in relation to smoking. Overall, among the employees of the hospital, the smoking prevalence was 47%, (42% among physicians and 43% among nurses); 30% admitted smoking in the hospital and three quarters of the smokers would like to quit. Some knowledge, opinions and attitudes differ statistically among the smoking categories. For example, only 35% of the smokers admitted that smoking is more dangerous to health than atmospheric and car pollution compared with 60% of the ex or never smokers (p=0.04). Fewer smokers realize that their behavior is seen as a role model by patients. A greater percentage of smokers state that patients (34%) and visitors (43%) often smoke in hospital and these percentages are significantly higher than those reported by ex or never smokers (p≤0.05). All smokers claim that they never smoke in patient rooms, infirmaries and clinics, whereas over 20% of ex or never smokers report that smoking sometimes occurs in these places (p=0.015). The mean concentration of PM 2.5 in the 25 rooms was 2.4 μg/m3 with a range from 1 to 7 μg/m3. This study implies that the prevalence of smoking among health professionals may be very high, and might be twice the rate observed in the general population. Generally, smokers report less knowledge compared with ex and never-smokers and it seems that they systematically underestimate the dangers related to smoking both in their knowledge and in their behavior, and try to socially "normalize" smoking. All this and the evidence of cigarette butts in hospital rooms and clinics, notwithstanding the good quality of the air thanks to the modern ventilation system, imply that there is still a long way to go towards a smoke-free hospital.

Risk factors for catheter-associated urinary tract infection in Italian elderly

Catheter-associated urinary tract infections (CAUTIs) are the most common cause of hospital-acquired infections, especially in elderly patients. Data on CAUTIs in older persons in acute care settings are lacking, however. This study aimed to describe the epidemiology of CAUTIs and related outcomes (ie, length of stay and mortality), in patients admitted to an acute geriatric care hospital in central Italy. A CAUTI surveillance program was implemented from October 2011 to April 2012, according to the Centers for Disease Control and Prevention's National Healthcare Safety Network methodology. A total of 2773 patients aged ≥65 years were included in the study, and 483 catheterized patients were monitored for the risk of CAUTI. The catheterization rate was 16.7% (95% confidence interval [CI], 15.3%-18.2%), and the overall CAUTI incidence rate was 14.7/1000 device-days (95% CI, 11.7-18.3/1000). Mortality was significantly higher in catheterized patients with a CAUTI compared with noncatheterized patients (19.2% vs 10.5%; P < .05). Female sex (odds ratio [OR], 1.31; 95% CI, 1.06-1.67), increasing age (≥90 years: OR, 2.76; 95% CI, 2.00-3.83), and longer hospital stay before catheter insertion (≥15 days: OR, 2.90; 95% CI, 2.20-3.83) were independent risk factors for catheterization; increasing age (>90 years: OR, 2.75; 95% CI, 1.03-7.35), and duration of hospital stay before catheter insertion (OR, 2.41; 95% CI, 1.12-5.51) were associated with CAUTIs. These results underscore the importance of the proper choice of patients for catheterization, particularly in individuals aged >90 years.

Increase in mortality rate in patients with dementia treated with atypical antipsychotics: a cohort study in outpatients in Central Italy.

The purpose of this study was to investigate the risk of death among elderly outpatients (>65 years) with a dementia diagnosis treated with atypical antipsychotics. We conducted a cohort study of 696 patients who entered the Unit of Alzheimer Evaluation (UVA) of Teramo Hospital in Central Italy, during a 3-year period (January 2007-December 2009). Among these patients, 375 were treated with atypical antipsychotics (quetiapine, risperidone and olanzapine). Data were collected from record files sent to the pharmaceutical service of the hospital. Patients taking atypical antipsychotic medication were associated with a significantly higher mortality rate than patients not taking antipsychotics. The relative risk of death in patients treated with antipsychotics compared to control patients was 2.354 (95% CI 1.704-3.279). The greatest increases in mortality rate occurred close to the last drug supply, and declined exponentially as time passed from the last drug supply in patients who stopped drug assumption. Quetiapine was the most commonly prescribed drug and higher doses of this drug were associated with higher mortality rates. These results are in line with the April 2005 warning of the Food and Drug Administration (FDA) that among elderly patients with dementia, the treatment of behavioural disorders with atypical antipsychotics is associated with a higher mortality rate. Given the potential risks of mortality with antipsychotics, and since antipsychotic medications may benefit only a minority of patients, new approaches are clearly needed to manage the neuropsychiatric symptoms of dementia.

Measles among Healthcare Workers in a Teaching Hospital in Central Italy

The aim of this report is to describe a measles cluster involving health-care workers (HWCs) that occurred in a teaching hospital in central Italy during winter 2011 and the efforts made to promptly identify all the susceptible contacts in order to stop, as soon as possible, transmission of the infection within the hospital. An epidemiological investigation took place. The immunization status of all the exposed individuals was assessed by personal interviews (history of measles or measles vaccine). Serologie screening for personnel not immune to measles was performed. Four cases of measles infection in HCWs were identified; of the 72 HCWs tested for measles immunity, 50 reported a past history of measles, while 22 underwent serological screening, which showed that all were IgG positive except for one case, which was excluded from duty as recommended. Strict adherence to use of alcohol-based hand rub and rapid implementation of appropriate isolation precautions are essential but insufficient to prevent measles outbreaks in hospital settings. Vaccination is the only reliable protection against nosocomial spread of measles. Therefore, assessing the immunization status of HCW and implementing vaccination strategies are needed in order to virtually set to zero the risk of acquiring and spreading measles in healthcare settings.

Active training and surveillance: 2 good friends to reduce urinary catheterization rate

Because catheter-associated urinary tract infections (CAUTI) represent the most frequent health care-associated infection (HAI), we implemented an educational intervention on urinary catheter use to reduce the CAUTI rate. The intervention was focused on correct management of catheterized patients. To assess the participants' knowledge, pre- and post-tests were performed. An active CAUTI surveillance program took place in a 900-bed teaching hospital in central Italy before and after the educational intervention. CAUTI definition, catheterization rate, and CAUTI rate were expressed according to the Centers for Disease and Prevention/National Healthcare Safety Network definitions. The level of significance was set at P ≤ .05. Two hundred ninety-six health care workers attended the educational intervention; the analysis of the pre- and post-tests highlighted a statistically significant improvement (P < .05). Before the intervention, mean catheterization rate was 18.5% (95% confidence interval [CI]:18.1-18.9); 46 cases of CAUTI were detected, with an incidence rate of 6.6/1,000 catheter-days (95% CI: 4.8-8.8). After the intervention, mean catheterization rate was 9.2% (95% CI: 8.9-9.5); 19 cases of CAUTI were detected, with an incidence rate of 5.8/1,000 catheter-days (95% CI: 3.5-9.0). Through an active educational update and thanks to the implementation of a surveillance system, a successful reduction of catheterization rate was achieved. More efforts are needed to preserve this goal and to improve the CAUTI rate also.

Psychiatric Morbidity and Emotional Exhaustion Among Hospital Physicians and Nurses: Association With Perceived Job-Related Factors

ABSTRACT The objective of this study was to evaluate psychiatric morbidity and emotional exhaustion among physicians and nurses of a general hospital in central Italy, examining the association with perceived job-related factors. Anonymous questionnaires were distributed to all 323 hospital physicians and 609 nurses of a nonprofit health organization in Rome, Italy. Standardized instruments were used to evaluate psychiatric morbidity (General Health Questionnaire), burnout (Maslach Burnout Inventory), and perceived job-related factors. Logistic regression was used to examine the association between job-related factors, psychiatric morbidity, and burnout, controlling for demographic factors. Questionnaires were returned by 155 physicians and 216 nurses (overall response rate 40%). Estimated prevalence of psychiatric morbidity was 25% among physicians and 36.9% among nurses. Burnout on the emotional exhaustion scale affected 38.7% of physicians and 46.4% of nurses. Personnel with emotional exhaustion was at higher risk of psychiatric morbidity (p < .001). The likelihood of psychiatric morbidity among physicians was increased by perceived insufficient recognition of personal commitments by the unit's head (odds ratio [OR] = 4.21; 95% confidence interval [CI] 1.2–15.1; p = .027), insufficient managerial ability of the unit's head (OR = 3.45; 95% CI 1.2–10.1; p = .023), and unsatisfactory communication (OR = 5.30; 95% CI 1.6–17.6; p = .006). Among nurses, psychiatric morbidity was associated with insufficient ability of the unit's head to solve conflicts, insufficient decisional power in relation to responsibilities, insufficient economic rewards and career possibilities, and working in surgery. Similar job-related factors were associated also with emotional exhaustion. Psychiatric morbidity and emotional exhaustion were relatively high, particularly among nurses. Specific job-related factors were associated with psychiatric morbidity and burnout. Improving these aspects is important for the well-being of hospital staff and the quality of patient care.

Trend of emergency department presentations for influenza like illness: Differences between pandemic (2009-2010) and post-pandemic (2010-2011) season

The aim of this paper is to analyze differences between incidence, characteristics and out-comes of patients with Influenza Like Illness (ILI) presenting to a teaching public hospital in Central Italy during pandemic influenza season (2009-2010) and during the post-pandemic outbreak (2010-2011). We performed a retrospective descriptive study, and we identified Emergency Department (ED) presentations for ILI, relying on hospital discharge data administrative database. Bivariate analyses for the outcome of hospital admission were performed for both seasons and a multiple logistic regression model has been developed to evaluate which factors were independently associated with hospital admission. Among all the ED presentations (51,757), visits for ILI were respectively 821 (3.1%) during the pandemic season, and 704 (2.8%) during the post-pandemic one. The pandemic cohort differs significantly from the post-pandemic cohort for every characteristic investigated, with the exception of the length of stay in the ED. Overall in 2009-2010 there were more ED presentations compared to the following season, but hospital admission rates were less than in 2010-2011. Further studies are needed to assess if other variables may affect the use of the ED for ILI in order to try to plan staff and hospital organization.

Reporting of a surveillance system of multidrug-resistant organisms in an Italian hospital

Healthcare facilities are monitoring Multidrug-Resistant Organisms (MDROs) because of their increasing incidence. A surveillance system for MDROs isolated from routine clinical cultures was set up in a teaching hospital in Central Italy.