Local Healthcare Units Research Articles

Working conditions, missed care and patient experience in home care nursing in Italy: An observational study.

The aging of the population requires an appropriate knowledge of the type of care that needs to be provided to inform healthcare policies. In Italy, neither home care nursing, nor the patient experiences have ever been described. To describe the characteristics of nurses and care recipients involved in home care. A descriptive cross-sectional study conducted in 18 Italian Regions. Between April and October 2023, data from nurses and patients involved in home care were collected through two surveys. Psychosocial conditions in workplaces, missed care, and care experiences were assessed using validated tools. Descriptive statistics and Pearson's correlations were performed. A total of 46 local healthcare units were included in this study, with a total of 2549 nurses and 4709 care recipients. Nurses (mean age 46.60; 79.48% female; 44.68% regional nursing diploma as the highest qualification) reported good working conditions (42.37; SD=12.25; range=0-100) and a high mean number of missed care activities (5.11; SD=3.19; range 0-9). Most nurses (83.41%) reported high levels of job satisfaction, while 20.28% intended to leave their job. Patients (mean age 75.18; 57.57% female; 36.95% primary school), on the other hand, rated positively the care they had received (8.23; range=0-10). Despite the perception of critical issues at work and some missed care, satisfaction in nurses and patients was high. These data constitute a preliminary snapshot of the studied phenomena, which will be investigated through more in-depth analyses.

Health Conditions in Older Adults Suspected of Being Maltreated: A 20-Year Real-World Study.

Older adult maltreatment (OAM) is a global problem that has attracted increasing attention due to the ageing population and its severe impact on victim health. Thus, this study aims to analyse the prevalence of certain health conditions in people ≥ 60 years old whom physicians from a local healthcare unit suspected to be victims of maltreatment. The specific objectives are to determine the prevalence rates of health-related risk factors, traumatic injuries and intoxications, mental disorders, and physical disorders. We conducted a real-world, retrospective, observational, and cross-sectional study based on secondary data analyses of electronic health records and healthcare registers of patients at the Local Healthcare Unit of Matosinhos (2001-2021). Information was obtained based on codes from the International Classification of Diseases, codes from the International Classification of Primary Care, and clinical notes (according to previously defined keywords). We identified 3092 suspected victims of OAM, representing 4.5% of the total population analysed. This prevalence is lower than the known rates. We also found that some health risk factors, traumatic injuries and intoxications, mental health disorders, and physical disorders presented higher rates in the suspected victims than among the total population. In this age group, we cannot assume that these health problems are only related to a possible current victimisation process; they could also be associated with adverse childhood experiences or intimate partner violence, among other forms of violence, all of which can lead to cumulative effects on the victim's health. This evidence increases healthcare providers' responsibility in detecting and reporting all cases of suspected maltreatment.

Mothers' sense of coherence and oral health-related quality of life of preschoolers: a 3-year cohort study.

The aim of the present study was to assess whether mothers' sense of coherence (SOC) was a predictor of decline in oral health-related quality of life (OHRQoL) of preschoolers. A 3-year cohort study was conducted in Diamantina, Brazil. At baseline, 162 preschoolers aged one to three years were randomly selected from among children registered in local Primary Healthcare Units. In the first stage, mothers completed a sociodemographic questionnaire, the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS), and the Brazilian short version of the Sense of Coherence Scale (SOC-13). The total score obtained from the SOC-13 was used to select exposed and unexposed children. Clinical examinations were performed to detect the presence of dental caries, traumatic dental injury, and malocclusion. At follow-up, mothers completed the sociodemographic questionnaire and the B-ECOHIS again. The incidence of severe dental caries and adherence to the proposed treatment at baseline were evaluated. A decline in OHRQoL was considered if there was an increase in the B-ECOHIS score of at least one unit. The chi-square test and Poisson regression were performed. A total of 151 preschoolers participated in the study, among whom 37.7% showed a decline in OHRQoL. Mothers' SOC was not associated with a negative impact on OHRQoL (RR = 1.24; 95%CI = 0.81-1.88), while the incidence of severe dental caries had a greater impact on the decline in OHRQoL (RR = 2.02; 95%CI = 1.29-3.16). Mothers' low SOC was not a predictor of decline in the OHRQoL of preschoolers after a 3-year follow-up period.

Health Outcomes in Women Victims of Intimate Partner Violence: A 20-Year Real-World Study.

Intimate partner violence is characterized by violent actions against a person perpetrated by his or her former or current partner, regardless of cohabitation. It most frequently affects women, and one of its most relevant outcomes is the health problems associated with the experience of repeated violence. Thus, the main objective of this study is to analyse the prevalence of health problems among women for whom there was a medical suspicion of being victims of intimate partner violence. The specific objectives are to analyse the prevalence of (a) health risk behaviours; (b) traumatic injuries and intoxications; (c) mental health conditions; and (d) somatic diseases. We conducted a real-world, retrospective, observational, cross-sectional and multicentric study based on secondary data analyses of electronic health records and health care register data in patients of the Local Healthcare Unit of Matosinhos (between 2001 and 2021). The identified data were extracted from electronic health records corresponding to the Health Insurance Portability and Accountability Act Safe Harbor Standard. Information was obtained considering the International Classification of Diseases, the International Classification of Primary Care, and the Anatomical Therapeutic Chemical Classification System, as well as clinical notes (according to previously defined keywords). Considering all information sources, 1676 cases were obtained. This number means that just 2% of the women observed at this health care unit were suspected of being victims of intimate partner violence, which is far from the known statistics. However, we found much higher rates of all health risk behaviours, trauma and intoxication cases, mental health conditions, and somatic disorders we looked for, when compared to the general population. Early detection of these cases is mandatory to prevent or minimize their related health outcomes.

Administrative databases as a tool for identifying healthcare demand and costs in an over-one million population


 
 Background: the aim of this study was to assess healthcare demand of specific groups of population and their costs borne by Italian Health System, using healthcare administrative databases.
 Methods: demographic, clinical and economic data were obtained from datasets available at the Regional Health System, combined into a data warehouse (DENALI), using a probabilistic record linkage to optimize the data matching process. The study population consisted of more than 1 million people registered in 2005 at one Local Healthcare Unit of Lombardy. Eight different segments were identified. Costs occurring in 2005 for hospital admissions, drug prescriptions, outpatient medical specialist visits were quantified in each segment.
 Results: healthy people accounted for 53% of the population and cost € 180 per-capita. Subjects with only one chronic disease made up 16% of the population and cost € 916 per-capita, those affected by several chronic diseases accounted for 13% and cost € 3 457 per-capita. Hospitalizations were the cost driver in five segments, ranging from 42% to 89% of total expenditures. Outpatient visits were the cost driver among healthy subjects (54%) and those with a possible chronic disease (42%), while drug costs ranged between 4% (“acute event”) and 32% (“one chronic disease”). Overall, healthcare cost was € 809 per-capita.
 Conclusions: healthcare costs were mainly determined by people affected by chronic conditions, even if “healthy people” ranked third for total expenditure. These costs need an appropriate identification of healthcare demand, that could be efficiently monitored through the use of administrative databases.
 

Introducing New Paths towards Public Primary Healthcare Services in Greece: Efforts for Scaling-Up Mental Healthcare Services Addressed to Older Adults.

The exponential growth in the aging population challenges the Primary Care Providers (PCPs) who provide health care services to older adults who are considered highly vulnerable and are in need of specialized healthcare services. The development of new policies and the adoption of appropriate health strategies by PCPs may improve the early detection and prevention of mental disorders in older adults. This reduces both queuing and costs in outpatient clinics while preventing stigma for patients and families. To this end, specialized training for PCPs at the Local Primary Health Care Unit (LPHCU) was provided in order to conduct efficient assessments of older adults (65 and above years old, without previously diagnosed depression or dementia, and willing to participate). The assessment is based on the Mini Mental State Examination (MMSE) and Geriatric Depression Scale (GDS). Older adults identified with MMSE <20 and GDS >5 were referred to the psychiatric outpatient clinic. The aim of this study is to discuss evidence-informed policymaking in Greece with a focus on advancing mental health practices and scaling up quality primary healthcare services for older adults.

Pemanfaatan Tumbuhan Hutan sebagai Bahan Pengobatan Tradisional oleh Masyarakat Suku Dayak Meratus Kalimantan Selatan

The use of forest plants as medicinal materials is an essential part of the life of indigenous peoples, one of which is the Dayak tribe of the Meratus Mountains. This study aimed to analyze the use of plants as medicinal ingredients for the indigenous Cabai community in Patikalain Village, Hantakan District, Hulu Sungai Tengah Regency, which is part of the Meratus Mountains Dayak tribe. The method of data collection was done by semi-structured interviews. Selected respondents were determined by purposive sampling and snowball sampling techniques. Data were analyzed by tabulation matrix. There were 18 types of forest plants that were used as medicine by the indigenous people of Cabai. The most widely used plant habitats for medicinal purposes were shrubs/shrubs and trees. Roots and leaves were the most widely used plant parts in medicine. There were at least 23 diseases that could be treated with various types of plants. Forest plants were widely used for internal medicine compared to external medicine. Treatment using plant ingredients was the first alternative used by the community in medicine. If this did not work, then community members who were sick would be directed to seek treatment at the Local Health Care Unit. If modern medicine did not work, the next alternative, then additional treatment using traditional rituals, was the last option. This finding was a contribution to knowledge in the traditional medicine system of the local community.

Vaccine adhesion before and after Vaxzevria suspension in a Local Health Unit of Piedmont - Italy

Abstract Introduction The Oxford-AstraZeneca vaccine Vaxzevria is a viral-vector vaccine developed to prevent COVID-19 infection. Two doses scored 81.3% efficacy against symptomatic infection and 100% against hospitalization. In Italy, Vaxzevria use started in February. After two deaths among the Army, Italian Medicines Agency withdrawn the vaccine batch involved. News about fatal thrombosis increased, together with population concern. On March 14th, the Piedmont Region suspended another batch following a new time-related death. The following day, several European states suspended Vaxzevria administration waiting for indication from an EMA meeting on March 18th. The aim of Authors was to study the effect of suspension on adhesion among general population. Methods Authors registered vaccine adhesion of vaccination centers offering Vaxzevria. To access vaccination, people was requested to express willingness through a website. Then, access was granted with a summoning SMS or e-mail. Vaxzevria target populations were members of law enforcement agencies and school personnel of any age. Data from February 25th to April 12th form a Local Healthcare Unit in Piedmont Region (Italy). Results Vaccine adhesion ranged from 95 to 100% from February 25th to March 12th (mean 97%). During March 13th it decreased to 73%, then 48% on March 14th, the day of local withdraw of all Vaxzevria doses in Piedmont Region. Activity restarted on March 19th with a 65% of adhesion, and a mean of 75% (69-81%) in the following days. From March 24th-31th adhesion recovered, with a mean 89%. April 1st-12th recorded a plateau: 81-100%, mean 91%. From March 13th a total of 1478 people out of 8339 (17.7%) did not receive their scheduled vaccination. Conclusions Both news and official statements had an impact on trust and vaccine adhesion among population and dramatically slowed the COVID-19 vaccine campaign, with a possible effect on infection spreading. Further data and analysis will be provided in the following months. Key messages Vaxzevria temporary suspension had an impact on vaccine adhesion. Vaccine adhesion took one month to go back to previous values.

The Italian Master in Clinical Bioethics Consultation: 2013-2020 Experience

"This work is aimed at critically illustring the eight-year experience of the Master in “Clinical Bioethics Consultation” (2013-2020). This advanced second-level Master was promoted in 2013 by the Catholic University of the Sacred Heart of Rome, and co-worked by other Italian clinical as well as academic institutions (University Campus Bio-medico of Rome, Insubria University of Varese, “Federico II” University of Naples, Lanza Foundation of Padua, Local Health and Social Care Unit n. 7 (ULSS) of Veneto Region, Treviso; Ospedale San Giovanni Calibita Fatebenefratelli – Isola Tiberina, Rome, and Italian Group for clinical ethics consultation (GIBCE)). To this aim, it first will discuss two points: on the one hand, an epistemological one, i.e. the justification of the activity of ethics consultant in clinical settings supported by the authors; on the other hand, a pedagogical one, i.e. the identification of the learning needs clinical bioethics gives birth to. The second part of the work will focus on the experience of the Master, explaining its basic features (objectives, methods, contents, evaluation tools, etc), offering a critical review, and identifying the challenges this initiative has to face in the next future. "

The role of local primary healthcare units in increasing immunization uptake among children in vulnerable social groups through vaccination campaigns

The objective of this study was to evaluate the potential of a tailored health promotion and vaccination campaign conducted by a Local Primary Health Care Unit (LPHCU), in increasing children's immunization uptake of vulnerable social groups. The LPHCU of Ampelokipi, Larissa, Greece conducted an immunization campaign in accordance with the National Vaccination Program within a Roma settlement of Larissa, a population of approximately 4500 people, including 1500 children aged 2 months to 16 years. To ensure community engagement, the settlement's Roma mediator and the associated Medical Social Centre participated in the design and implementation of the campaign, facilitating coherent and precise communications about the campaign goals and methods. The campaign consisted of peer-to-peer communications with parents/guardians, followed by medical examination and vaccination of children, as well as scheduling of appointments for monitoring children's development. The communication messages presented vaccines as a health solution to parents and advised about personal hygiene and healthy diet habits. House-to-house health promotion visits were conducted to all houses of the settlement. From April 2019 to March 2020, a total of 704 vaccines were administered to 381 Roma children, conforming to the National Vaccination Programme of Greece. Our study demonstrated that LPHCU's have the potential to enhance confidence between healthcare providers and vulnerable social groups, towards disease prevention and to increase immunization uptake. Vaccination campaigns should be organized systematically at central country level, as part of continuing efforts of health promotion programs. Local health care providers can play a significant role in national campaigns for increasing vaccination coverage among vulnerable groups.

NUTRIENTS INTAKE EVALUATION IN COMMUNITY-DWELLING ADULT PATIENTS REQUIRING NUTRITIONAL ASSESSMENT.

In recent years, there has been growing interest in nutritional aspects of community patients, particularly the elderly [1]. The purpose of the study is to analyze nutrients intake in community-dwelling adult patients requiring nutritional assessment and correlations with clinical conditions. Data has been collected from 141 adult patients (M=64; F=77) registered in 2019 (1st October-31st December) at Home Artificial Nutrition (HAN) Department of Local Health Care Unit Naples 3, Italy. 24-Hour Recall Questionnaire was administered for investigating food intake. Student's t-test was used for statistical analysis. Mean age was 78 years, 89.4% were elderly (65+years) and 31.9% were aged over 85 years. The underlying disease was neurological in 56% and cancer in 29.8% of patients; 44 patients (31.2%) were bedridden with pressure sores and 76 (53.9%) referred unintentional weight loss. Patients reported dysphagia in 67.4% and loss of appetite in 43.3%. Mean energy intake was 867±328 kcal/day and proteins were 34.2±16.3 g/day. A statistically significant difference in mean energy and protein intakes was observed for older patients (85+years) (p=0.02; p=0.001), those with pressure sores (p=0.004; p=0.009) and those who reported loss of appetite (p=0.001; p=0.01). Mean fiber intake was very low in all patients (8.9±5.2 g/day). Inadequate nutrients intake is frequent in dwelling-community adult patients, particularly in the elderly. Timing of nutritional assessment and appropriate intervention could reduce chronic disease risk.

RARE ORPHAN DISEASES IN PATIENTS ON HOME ARTIFICIAL NUTRITION.

Rare genetic and non-genetic diseases are often associated with high risk of malnutrition[1]. The purpose of the study is to evaluated rare diseases among patients on Home Artificial Nutrition (HAN) and prescriptions registered at Local Health Care Unit Naples 3, Italy. Data were collected from 231 patients (M=131; F=100) recorded in 2019 (1st January-31st December). Oral Nutritional Supplements (ONS), Enteral Nutrition (HEN), Parenteral Nutrition (HPN) were included; complications of pregnancy and childbirth were excluded. Adults were 182 (78.8%), Pediatrics 49 (21.2% ). Rare diseases of the nervous system were 177 (76.7%), congenital anomalies 25 (10.8%) and inborn errors of metabolism 8 (3%). Respiratory, hematologic, immunologic, and skin diseases, primitive glomerulopathies and intestinal disorders, rare tumors were found in fewer cases (9.1%). Amyotrophic Lateral Sclerosis was the most frequent diagnosis (43.3%; 94 ALS and 6 ALS-Juvenile). Spinal Muscolar Atrophy (SMA) was found in 23.8% of pediatrics, Progressive Supranuclear Palsy (PSP) and Duchenne Muscular Dystrophy (DMD) in 8.4% and 4.5% of adult patients. ONS were 123, mainly prescribed to adults (87%); HEN were 100, administered through Percutaneous Endoscopy Gastrostomy (86%) and nasogastric tube feeding (14%), HPN were only 9 prescriptions. Nutritional impairment in patient with rare neurologic diseases is frequent. HAN could improve clinical management of symptoms worsening quality of life of patients. Further research is needed to evaluate the impact of nutritional intervention on individual clinical outcome[1].

Sun exposure, dressing habits, and vitamin D status in Morocco

Sunlight is the main source of vitamin D. Almost 80% of vitamin D3 is produced in the skin. The region of Draa Tafilalet benefits from long daily sunshine time. As such, vitamin D deficiency should be low in this region. However, dressing habits can highly influence vitamin D status. This study aimed to evaluate sun exposure and its relation to vitamin D status among the general population in the region of Draa-Tafilalet, Morocco. Clinical, biological, and sociodemographic data were obtained from 331 adults visiting local healthcare units during the summers of 2019 and 2020. Plasma 25(OH)D2/D3 was measured by immunofluorescence. The prevalence of vitamin D deficiency was 37.5%, while Vitamin D insufficiency represented 56.5%. Most of the studied population (76.4%) had restricting dressing habits and exposed only their faces. statistic tests showed a correlation of vitamin D levels with daily sun exposure (r= 0.308, p&lt;0.001), dressing habits (p&lt;0.001), age (r= -0.141, p=0.01), sex (p&lt;0.001), physical activity level (p=0.003), and BMI (r= -0.298, p&lt;0.001). The study showed a high prevalence of vitamin D deficiency in this region. Similarly, it exposed the effects of restricting clothes and low daily sun exposure on vitamin D status.

Emergency Department Overcrowding: A Retrospective Spatial Analysis and the Geocoding of Accesses. A Pilot Study in Rome

The overcrowding of first aid facilities creates considerable hardship and problems which have repercussions on patients’ wellbeing, the time needed for a diagnosis, and on the quality of the assistance. The basic objective of this contribution, based on the data collected by the Hospital Policlinico Umberto I in Rome (Lazio region, Italy), is to carry out a territorial screening of the municipality using GIS applications and spatial analyses aimed at reducing—in terms of triage—code white (inappropriate) attendances, after having identified the areas of greatest provenance of improperly used emergency room access. Working in a GIS environment and using functions for geocoding, we have tested an experimental model aimed at giving a close-up geographical-sanitary look at the situation: recognizing the territorial sectors in Rome which contribute to amplifying the Policlinico Umberto I emergency room overcrowding; leading up to an improvement of the situation; promoting greater awareness and knowledge of the services available on the territory, a closer relationship between patient and regular doctor (general practitioner, GP) or Local Healthcare Unit and a more efficient functioning of the emergency room. In particular, we have elaborated a “source” map from which derive all the others and it is a dot map on which all the codes white have been geolocalized on a satellite image through geocoding. We have produced three sets made up of three digital cartographic elaborations each, constructed on the census sections, the census areas and the sub-municipal areas, according to data aggregation, for absolute and relative values, and using different templates. Finally, following the same methodology and steps, we elaborated another dot map about all the codes red to provide another kind of information and input for social utility. In the near future, this system could be tested on a platform that spatially analyzes the emergency department (ED) accesses in near-real-time in order to facilitate the identification of critical territorial issues and intervene in a shorter time to regulate the influx of patients to the ED.

Speech therapy model for patients with cleft palate in Lao People’s Democratic Republic: Lack of speech services

BackgroundA majority of children with cleft lip and palate (CLP) have persistent speech and language problems after repair. Speech services are critically needed for these children in some developing countries where there is a lack of or no speech services. This includes the Lao People's Democratic Republic (LPDR) where accessibility to speech therapy is not an attainable medical specialty. ObjectiveTo establish and determine the effectiveness of speech therapy model in reduction of the number of articulation errors for children with CLP in LPDR where these services are lacking. MethodsSpeech therapy for children with CLP in LPDR by using the adapted Khon Kaen University Speech Therapy Model based on combining the principles of Community-Based Rehabilitation (CBR), Primary Health Care (PHC) and institutional medical approaches was provided for children with CLP in Bokeo, LPDR. Twelve children with CLP (3.6–16 years) were recruited for this study. Demonstration and teaching services for both speech assistants (SAs), who were local health care providers, and caregivers were performed in 3-day intensive speech camps. Three 1-day follow-up speech camps and 3 site visits were conducted by Thai speech and language pathologists (TSLPs) and their teams. SAs provided speech correction at local health care units based on TSLPs’ individual monitoring and supervision. Caregivers practiced assigned exercises at home. Speech Therapy Model in LPDR was undertaken for 1 year. ResultsThe Speech Therapy Model in LPDR was one of the effective models and significantly reduced number of articulatory errors (mean difference = 6.42; 95% confidence interval = 3.01, 9.83).

Intellectual capital in Italian healthcare: senior managers' perspectives

PurposeThis study investigates the perceptions of intellectual capital (IC) among senior managers at Italian local healthcare units (LHUs) and the interrelations among IC components. It also provides a comprehensive definition of IC in the healthcare context and managerial guidance on improving IC to enhance LHU performance.Design/methodology/approachA survey was carried out to investigate perceptions among LHU senior management and identify characteristics of each primary IC component. The pilot study's results were examined using principal component analysis.FindingsThe findings illustrate senior management's perceptions of IC in LHUs and the extent to which management identifies and manages IC. A comprehensive definition of IC components in the healthcare sector is derived from these findings.Research limitations/implicationsThe research provides a better understanding of IC in the healthcare context and facilitates further research into how IC may be incorporated in quotidian organizational procedures. Results suggest that LHU managers should invest in increasing trust and respect and engage employees in organizational processes to provide recognition for the active role they play. Ongoing management of the three primary IC components is shown to have clear advantages, particularly on their connectivity.Originality/valueThe paper contributes to an increasingly important strand of theoretical research – IC in the healthcare context – and also adds new knowledge on the practical applications of IC in LHUs.

Understanding COVID-19 – The Pandemic of 2020

It all started in December 2019, a seafood market in Wuhan, China, with a series of pneumonia alike cases admitted with severe acute respiratory depression. Since they were unable to detect the precise cause, they named it "Pneumonia of unknown etiology". Later it was identified as SARS COV 2 (Severe Acute Respiratory Syndrome – coronavirus 2). At first, the disease spread locally affecting the people of Wuhan, and then started spreading throughout China, creating a worldwide panic. The World Health Organization (WHO) declared COVID-19 in China as a Public Health Emergency of International Concern. The Center for Disease Control and Prevention (CDC) from China and local healthcare units organized an intensive outbreak investigation program. The causative organism of this infection is a new virus that belongs to the “coronavirus (CoV)” family. After which the disease was called nCoV-19 (Novel coronavirus – 19). On February 11, 2020, the WHO Director General, Dr. Tedros Adhanom Ghebreyesus, renamed the disease as "COVID-19," which is the acronym of "coronavirus disease 2019". Viral epidemics like SARS-CoV in 2002, H1N1 influenza in 2009, and the most recent one the MERS-CoV Middle East Respiratory Distress Syndrome Coronavirus (first identified in Saudi Arabia) in 2012 threatened the health of mankind in the past two decades. All of these were successfully prevented by systematically approaching the problem to solve it. Healthcare professionals around the world are well trained to manage any type of health crisis. On March 11, 2020, the WHO declared COVID-19 as a "PANDEMIC" pointing to over 118,000 cases and 80,000 dead in 110 countries or more. In a media briefing, the WHO Director General said: "This is not just a public health crisis, it is a crisis that will touch every sector, so every sector and every individual must be involved in the fight."

Critical failures in the use of home ventilation medical equipment

Home ventilation involves the use of medical devices at patient's home by personnel who are not healthcare practitioners. This implies new potential risks not fully addressed by current standards and guidelines. A methodological approach to investigate potential failures and define improvement actions to address the dangerous potential situations in HV is required.A multidisciplinary team performed an extended version of Failure Mode, Effect and Criticality Analysis (FMECA) to analyse the home ventilation service provided by the Local Healthcare Unit of Naples (ASL NA1) that assisted 60 homebound ventilator dependent patients. The failures were identified in three risk areas: device, electrical system & fire hazard, and indoor air quality. The corrective actions were formulated with two extra steps: identification of critical failures with a threshold applied to the risk priority number and analysis of causes by means of contributory factors (Organization, Technology, Information, and Structure) based on Reason's theory of failures.22 of 86 potential failures were identified as critical. Specific corrective actions were addressed and proposed through contributory factors to improve the overall quality of home ventilation service.The use of this systemic approach oriented the improvements to reduce the harms caused by vulnerabilities in high-risk care service as life support home ventilation.

MON-PO553: Home Artificial Nutrition (HAN) in a Southern Italy Local Health Care Unit (LHCU)

MON-PO553: Home Artificial Nutrition (HAN) in a Southern Italy Local Health Care Unit (LHCU)

ВИДОВИЙ ПРОФІЛЬ МІКРОБНИХ ЧИННИКІВ НОЗОКОМІАЛЬНИХ ІНФЕКЦІЙ

Nosocomial infections, also known as health care-associated infections (HAIs) are infections that appear in patients under medical care in hospitals or other health care facilities and were absent at the time of admission. From 5 to 7 thousand cases of HAIs are registered in Ukraine every year, but according to experts, the actual number is 900 thousand cases per year. Intensive care unit (ICU) represents a prominent tool in HAIs control and quality assurance in many developed countries. In this respect, the US Center for Disease Control and Prevention (CDC) recommends monitoring HAI as a leading tool for the reduction of HAIs. Therefore, the aim of this research was to investigate microbiological profile of nosocomial infections in ICU of public hospitals in Lviv, Ukraine. Material and methods. 105 clinical materials from 50 patients in two public hospitals in Lviv (Lviv Regional clinical hospital and Military Medical Clinical Center of the Western Region) were analyzed during July-December 2018. 114 strains of pathogens were isolated. HAIs was defined as an infection that appeared in patients later than 48 hours after admission to the hospital. Urinary tract infections (UTI), blood stream infection (BI), respiratory tract infection (RTI) and surgical site infections (SSI) were diagnosed using the criteria defined by the CDC and clinical protocols. Causative bacterial strains were isolated and identified using standard methods and chromogenic media CHROMID*S.aureusElite, CHROMID*VRE, CHROMID*MRSASMART, CHROMID*CARBASMART, CHROMID* ESBL, CHROMID*OXA-48, CHROMID*Candida (Biomerieux) and biochemical identification kitsMIKRO-LA-TESTNEFERMtest24, ENTEROtest24, CANDIDAtest21, STAPHYtest24, STREPTOtest24 (ErbaLacema, Czech Republic). Antibiotic sensitivity test was done using Kirby-Bauer disc diffusion technique. (Ethical Committee or Institutional Animal Care and Use Committee Approval Danylo Halytsky Lviv National Medical University: 25/06/2018 № 6). HAIs structure was as follows: Staphylococcus lentus (22%), Eschrichia coli (22%), Klebsiella pneumoniae subsp.ozaenae (9.8%), Pseudomonas aeruginosa (43.9%), Klebsiella pneumoniae subsp.pneumonia (8.8%), Srreptococcus spp. (7.0%), Burkholderia pseudomallei (5.3%), Staphylococcus haemolyticus (3.5), Staphylococcus aureus (3.5%). There were several types of HAIs which are rarely found, such as Staphylococcus lentus, Staphylococcus simulans, Staphylococcus lugdunensis, Aerococcus viridans, Pragia fontium, Aeromonasichthiosmia, Raoultella terrigena, Macrococcus caseolyticus. Conclusions. In the era of antibiotics, HAIs are still uncontrollable. It is assessed that over 90.0% of HAIs are not recognized as epidemics. It is important to remember this fact when attempting to design prevention or control strategy to reduce HAIs either at WHO level, or at the level of local health care unit.