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Pillars for prevention and control of healthcare-associated infections: an Italian expert opinion statement.

ABSTRACT: Healthcare-associated infections (HAIs) represent a relevant problem for all healthcare facilities, because they involve both the care aspect and the economic management of the hospital. Most HAIs are preventable through effective Infection Prevention and Control (IPC) measures. Implementation and improvement of IPC programs are critical to reducing the impact of these infections and the spread of multi-resistant microorganisms. The purpose of this Expert Opinion statement was to provide a practical guide for healthcare organizations, physicians, and nursing staff on the optimal implementation of the core components of Infection Prevention and Control, as recommended by a board of specialists after in-depth discussion of the available evidence in this field. According to their independent suggestions and clinical experiences, as well as evidence-based practices and literature review, this document provides a practical bundle of organizational, structural, and professional requirements necessary to promote, through multimodal strategies, the improvement of the quality and safety of care with respect to infectious risk in order to protect the patient, facilities, and healthcare providers.

SUBMITTER: Puro V

PROVIDER: S-EPMC9207866 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature

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Pillars for prevention and control of healthcare-associated infections: an Italian expert opinion statement.

Puro Vincenzo V Coppola Nicola N Frasca Andrea A Gentile Ivan I Luzzaro Francesco F Peghetti Angela A Sganga Gabriele G

Antimicrobial resistance and infection control 20220620 1

Healthcare-associated infections (HAIs) represent a relevant problem for all healthcare facilities, because they involve both the care aspect and the economic management of the hospital. Most HAIs are preventable through effective Infection Prevention and Control (IPC) measures. Implementation and improvement of IPC programs are critical to reducing the impact of these infections and the spread of multi-resistant microorganisms. The purpose of this Expert Opinion statement was to provide a pract ...[more]

PMID: 35725502

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Project description:IntroductionChronic hand eczema (CHE) is an inflammatory skin condition characterized by different pathomechanisms, clinical presentations, and prognoses. Treatment is often challenging because of limited approved drugs, and severe CHE is associated with reduced quality of life (QoL) and poor overall health measures in terms of psychological, functional, and occupational challenges. This study aims to describe the real-life management practices of Italian dermatologists who frequently treat patients with CHE, compare these practices with existing guidelines, and propose practical clinical recommendations for the management of these patients.MethodsAn 11-question survey was administered to 14 participating dermatologists to gather their insights on the diagnosis, treatment, and management of CHE. Moreover, a comprehensive literature search was conducted over the previous 10 years as a starting point for discussion among experts.ResultsCHE was the reason for 6.9% of dermatological consultations by the 14 experts. Median time to CHE diagnosis was 12 (range: 2-24) months. Fissuring and itching (85.7% for both) were the most frequently reported signs and symptoms of CHE. The survey highlighted the need for long-term treatment that is effective and well tolerated, with experts emphasizing the importance of improving disease awareness among physicians and patients. Practical clinical approaches were proposed, emphasizing the significance of a thorough medical history and identification of symptoms in the management of CHE. Experts advocated for specifically developed CHE treatment approaches, concentrating on alleviating symptoms and signs, minimizing adverse events/safety issues, enhancing the QoL of patients, and long-term disease control. Findings from this survey were further discussed and compared to recommendations of the available guidelines for the management of CHE.ConclusionsManaging CHE requires a comprehensive approach that considers both objective clinical factors and subjective patient expectations. Experts emphasized the need for effective and well-tolerated long-term therapies, improved disease awareness, and communication among physicians and patients.

Project description:The prescribing and use of opioid analgesics is increasing in Italy owing to a profusion in the number and types of opioid analgesic products available, and the increasing prevalence of conditions associated with severe pain, the latter being related to population aging. Herein we provide the expert opinion of an Italian multidisciplinary panel on the management of opioid-induced constipation (OIC) and bowel dysfunction. OIC and opioid-induced bowel dysfunction are well-recognised unwanted effects of treatment with opioid analgesics that can profoundly affect quality of life. OIC can be due to additional factors such as reduced mobility, a low-fibre diet, comorbidities, and concomitant medications. Fixed-dose combinations of opioids with mu (μ) opioid receptor antagonists, such as oxycodone/naloxone, have become available, but have limited utility in clinical practice because the individual components cannot be independently titrated, creating a risk of breakthrough pain as the dose is increased. A comprehensive prevention and management strategy for OIC should include interventions that aim to improve fibre and fluid intake, increase mobility or exercise, and restore bowel function without compromising pain control. Recommended first-line pharmacological treatment of OIC is with an osmotic laxative (preferably polyethylene glycol [macrogol]), or a stimulant laxative such as an anthraquinone. A second laxative with a complementary mechanism of action should be added in the event of an inadequate response. Second-line treatment with a peripherally acting μ opioid receptor antagonist (PAMORA), such as methylnaltrexone, naloxegol or naldemedine, should be considered in patients with OIC that has not responded to combination laxative treatment. Prokinetics or intestinal secretagogues, such as lubiprostone, may be appropriate in the third-line setting, but their use in OIC is off-label in Italy, and should therefore be restricted to settings such as specialist centres and clinical trials.

Project description:BackgroundIn the literature, there is absent or weak evidence on the effectiveness of biosecurity measures to the control of Salmonella spp. and hepatitis E virus (HEV) on pig farms. Therefore, the present study aimed to collect, weigh, and compare opinions from experts on the relevance of several biosecurity measures. An online questionnaire was submitted to selected experts, from multiple European countries, knowledgeable on either HEV or Salmonella spp., in either indoor or outdoor pig farming systems (settings). The experts ranked the relevance of eight biosecurity categories with regards to effectiveness in reducing the two pathogens separately, by assigning a score from a total of 80, and within each biosecurity category they scored the relevance of specific biosecurity measures (scale 1-5). Agreement among experts was analysed across pathogens and across settings.ResultsAfter filtering for completeness and expertise, 46 responses were analysed, with 52% of the experts identified as researchers/scientists, whereas the remaining 48% consisted of non-researchers, veterinary practitioners and advisors, governmental staff, and consultant/industrial experts. The experts self-declared their level of knowledge but neither Multidimensional Scaling nor k-means cluster analyses produced evidence of an association between expertise and the biosecurity answers, and so all experts' responses were analysed together without weighting or adaptation. Overall, the top-ranked biosecurity categories were pig mixing; cleaning and disinfection; feed, water and bedding; and purchase of pigs or semen, while the lowest ranked categories were transport, equipment, animals (other than pigs and including wildlife) and humans. Cleaning and disinfection was ranked highest for both pathogens in the indoor setting, whereas pig mixing was highest for outdoor settings. Several (94/222, 42.3%) measures across all four settings were considered highly relevant. Measures with high disagreement between the respondents were uncommon (21/222, 9.6%), but more frequent for HEV compared to Salmonella spp.ConclusionsThe implementation of measures from multiple biosecurity categories was considered important to control Salmonella spp. and HEV on farms, and pig mixing activities, as well as cleaning and disinfection practices, were perceived as consistently more important than others. Similarities and differences in the prioritised biosecurity measures were identified between indoor and outdoor systems and pathogens. The study identified the need for further research especially for control of HEV and for biosecurity in outdoor farming.

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Pillars for prevention and control of healthcare-associated infections: an Italian expert opinion statement.

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Pillars for prevention and control of healthcare-associated infections: an Italian expert opinion statement.

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