Giovanni Guarducci

Surgical Site Infections (SSIs) are among one of the most frequent and costly healthcare-associated infections (HAIs), leading to increased patient morbidity, prolonged hospital stays, and higher healthcare costs. Surveillance programs are essential for detecting, monitoring, and preve nting SSIs. However, the implementation and effectiveness of these programs varies across healthcare facilities. This study aims to provide effective data gathered from SSI trend assessment at Ferrara Teaching Hospital to improve surveillance systems. A retrospective study was conducted on data collected between 2020 to 2023 from the SIChER surveillance system and Hospital Discharge Cards at Ferrara Teaching Hospital. The analysis examined infection rates across various surgical procedures, applying two primary indicators: SSI Percentage by Category and Incidence Density of Hospital-Onset SSIs. Statistical analyses were performed using STATA software. An average of 5,158 surgical procedures were executed annually between 2020 to 2023, and SIChER-monitored procedures steadily increased during this period, reaching 80.7% coverage in 2023. The highest infection rates were recorded in colon surgery, while cardiac surgery consistently recorded no infections. The overall incidence density of hospital-onset SSIs was 0.18 per 1,000 follow-up days, with significant variations across surgical categories. The accuracy of HDCs in documenting SSIs improved over time, achieving a 97.2% match in 2023. The study highlights an increasing trend in SSI surveillance coverage and accuracy, demonstrating the effectiveness of the SIChER system in monitoring infections. However, variations in infection rates among different procedures suggest the need for targeted strategies, particularly for high-risk surgeries such as colorectal and orthopaedic procedures.

Introduction: According to Italian Law, citizens have the right to choose the preferred place of care; in this context, the competition between various hospitals across the national territory is inevitable. The study aims to analyze the associations between patient mobility between Tuscany (Italy) and other Italian regions and the weight of Diagnosis Related Groups (DRGs) provided for these hospitalizations, as a proxy of complexity of care provided.Methods: A retrospective study was conducted using 2019 and 2022 Hospital Discharge Cards data of Tuscany provided by the Italian Ministry of Health. The surgical DRGs of each Major Diagnostic Categories (MDCs) were considered according to high specialty (HS) and non-high specialty (N-HS). For each MDCs, patient attractions and escapes to bordering and non-bordering regions with Tuscany were associated with HS and N-HS surgical discharge DRGs by using Odds Ratios (OR). The analysis was performed thought STATA software, and the significance level was set at 95%.Results: In studied period, for Digestive Diseases (in 2019 OR: 1.37; 95%CI: 1.08–1.74; in 2022 OR: 1.66; 95%CI: 1.29–2.12), patients from non-border regions were more likely to be attracted to the Tuscany hospitals for HS DRGs, while for Musculoskeletal Diseases (in 2019 OR: 0.51; 95%CI: 0.47–0.56; in 2022 OR: 0.53; 95%CI: 0.48–0.59), those from non-border regions were less likely to be attracted for HS DRGs (p < 0.05). For the same years, for Nervous Diseases (in 2019 OR: 3.08; 95%CI: 2.18–4.37; in 2022 OR: 2.27; 95%CI: 1.60–3.22) and for Hepatobiliary and Pancreas Diseases (in 2019 OR: 4.56; 95%CI: 2.71–7.68; in 2022 OR: 4.19; 95%CI: 2.35–7.47). Tuscan patients were more likely to escape to non-border regions for HS DRGs while for Musculoskeletal Diseases (in 2019 OR: 0.76; 95%CI: 0.68–0.84; in 2022 OR: 0.83; 95%CI: 0.72–0.89) they were less likely to be admitted to non-border regions for HS DRGs (p < 0.05).Conclusion: The findings highlight the need to implement interregional agreements to optimize patient mobility, avoid duplication of services, reduce costs and improve access to care.

Background and Objectives: Pediatric Sjögren’s syndrome is a rare autoimmune disease with a heterogeneous clinical expression and limited pediatric-specific diagnostic criteria. Ocular involvement often represents an early manifestation, yet it may go unrecognized in children due to poor symptom reporting and the underuse of objective diagnostic tools. This retrospective study evaluated six pediatric patients with Sjögren’s syndrome, integrating systemic and ocular findings with a focus on early immunological and clinical markers. Materials and Methods: All patients underwent ophthalmological assessments, including tear break-up time, Schirmer’s test, and slit-lamp examination. Results: Tear break-up time values consistently indicated tear film instability (mean RE 7.4 ± 2.5 s; LE 7.7 ± 2.3 s), while Schirmer’s test showed greater variability. Slit-lamp examination revealed inhomogeneous tear films in all patients and blepharitis in 66.7%, consistent with Meibomian gland dysfunction. Systemic features included arthralgia, Raynaud’s phenomenon, fatigue, and frequent seropositivity for ANA and anti-SSA/Ro antibodies. Minor salivary gland biopsy confirmed lymphoepithelial sialadenitis in all cases. Conclusions: These findings highlight the importance of combining laboratory and clinical markers with ophthalmological parameters to support an early diagnosis of Sjögren’s syndrome in pediatric patients. Integrating TBUT and slit-lamp evaluation with serological and histopathological data may enhance diagnostic accuracy and guide timely, targeted intervention to prevent long-term complications.

Healthcare-associated infections (HAIs) are a significant healthcare complication, with major implications for public health. In the EU/EEA, up to 2.6 million new HAIs cases occur annually, causing significant burdens and economic costs. In Italy, the prevalence of HAIs is rising due to factors like invasive devices, antibiotic resistance, and poor infection control. The aim of this work is to evaluate the effectiveness of HAIs containment practices in long-term care facilities (LTCF). This cross-sectional study included eight LTCF inspected by Prevention Technicians of the Local Health Authority Tuscany South-East (LHA-TSE) in 2023. The study evaluated non-compliance in procedures for legionellosis prevention, cleaning and disinfection, laundry management, management of pans, HAIs prevention, healthcare tools disinfection, and hairdressing services. Data were analysed using descriptive statistics and the Mann Whitney test to compare infection rates with procedure compliance. In 2023, 606 infections were reported in the eight enrolled LTCF. The most frequent infections were COVID-19 (19.4%), urinary tract infections (16.9%), pharyngitis (15.6%), and influenza-like illness (ILI) (15%). For the "Laundry Procedure," 3 LTCF were compliant and 5 were not, showing a significant relationship with influenza syndromes (p = 0.02) and surgical site infections (p = 0.04). For the "Cleaning Check" procedure, non-compliance was linked to higher fungal infections (p = 0.01) and gastroenteritis (p = 0.04). The "Disinfection of Health Tools procedure showed non-compliance correlated with higher gastroenteritis (p = 0.04) and conjunctivitis (p = 0.01). Gastrointestinal infections from Clostridium difficile were linked to non-compliance with "HAIs Procedures Routes" (p = 0.04), "Pans" processes (p = 0.04), and cleanliness in the hairdressing service (p = 0.04). Herpes simplex or Herpes zoster infections were higher in LTCF with non-compliant hairdressing service rooms (p = 0.02). Two legionellosis cases were recorded in LTCF with reported non-compliance in analytical procedures for Legionellosis. Our analysis showed significant correlations between cleanliness procedures and reductions in fungal infections, gastroenteritis, and ear infections. Compliance in laundry procedures was linked to ILI and surgical site infections. Non-compliance in healthcare tools correlated with higher rates of gastroenteritis and conjunctivitis, highlighting the need for stronger practices. The data suggest that effective prevention measures reduce HAIs, though discrepancies in implementation across facilities call for standardization and continuous monitoring.

Background/Objectives: As life expectancy rises and the epidemiological landscape of chronic diseases evolves, the necessity to assess and improve the overall health status of the population becomes increasingly fundamental. Therefore, evaluating health gains is a crucial challenge for modern health systems, particularly in the context of limited resources and increasing demand for services. The aim of this study is to assess health gains and their costs, with data provided by a private Italian clinic. Methods: We conducted a retrospective study on 129 patients admitted between June 2020 and August 2023 in a solvent ward for short-term planned hospitalization. The patients completed the EQ-5D-5L questionnaire at both admission and discharge. Quality-Adjusted Life Years (QALYs) were estimated based on the difference in EQ-5D-5L scores between discharge and admission, assuming that health gains persist up to two years post-discharge. Through QALYs value and hospitalization cost, a cost–utility analysis was performed. Descriptive and statistical analyses were carried out using STATA SE/14.0 software. Results: Of the studied sample, 55% was female, the median age was 81 [11] years old, and the median length of stay (LoS) was 16 [16] days. The patients gained, in median, 0.33 [0.38] in QALY, which was higher for males (0.35 [0.34]) than females (0.29 [0.45]). The QALY gained was greater for the non-geriatric patients (0.41 [0.42]) than geriatric ones (0.32 [0.38]) (p > 0.05). Those with a longer LoS showed a higher gain in QALY (0.35 [0.42]) than those with a shorter one (0.23 [0.29]) (p < 0.05). The cost per QALY gained was, in median, EUR 14,337, which was lower in males (EUR 13,803), in non-geriatric patients (EUR 13,743), and in patients with a shorter LoS (EUR 10,670) (p > 0.05). Conclusions: Although QALY gains differed among the groups, the median cost per QALY remained consistent. These results highlight the need for targeted interventions to optimize resource allocation, both by integrating data into allocation strategies and by employing a multidisciplinary approach to tailor interventions.

Background: With the increase in life expectancy, more patients are undergoing total hip arthroplasty, primarily due to the rising incidence of osteoarthritis. The outcomes of rehabilitation following these surgical interventions are influenced by various factors. This study aims to explore the impact of age, gender, and body mass index (BMI) on pain and functional and rehabilitative outcomes after surgical hip prosthesis rehabilitation. Methods: We enrolled all patients admitted to a private clinic from January 2021 to December 2023 for rehabilitation after unilateral hip arthroplasty. For each patient, we collected data of Barthel Index, Tinetti Scale, Numeric Rating Scale (NRS), and range of motion (ROM) at the beginning and end of the hospitalization. We assessed whether the evaluated outcomes differed based on gender, age, and BMI using the Mann–Whitney and Kruskal–Wallis tests. Results: A total of 2.167 patients were studied (56% female and 36.5% over 75 years old). Male patients, adults (18–64 years), and those with a BMI < 30 showed higher values of Barthel Index, Tinetti Scale, and ROM at both admission and discharge (p < 0.05), along with significantly lower NRS scores. Each subgroup based on age, gender, and BMI showed an improvement in NRS (difference between admission and discharge) of at least 40%, it was about 50% for men and adults. The improvement in ROM (difference between admission and discharge) was more than 10% in both active and passive flexion, around 20% for passive abduction, and 50% for active abduction, with no significant differences based on age, gender, or BMI. Conclusions: Despite the absence of specific contraindications for arthroplasty procedures, a high BMI, age over 75 years, and female gender are associated with slightly worse functional and rehabilitation outcomes compared to other patients undergoing the same procedures. A preoperative screening for the evaluation of osteopenia, osteoporosis, and BMI could be a valuable tool for studying and improving outcomes in these patients.

Background: Examining information sources, communication channels, and preferred content formats is crucial for adapting and improving future communication strategies in vaccination campaigns. This study aims to evaluate the information and communication preferences regarding the booster dose of Covid-19 among employees of the Central Tuscany Local Health Authority (CT-LHA). Methods: From July to October 2022, a questionnaire was administered to 7,000 out of approximately 15,000 CT-LHA employees. The questionnaire analyzed communication, organizational, and access aspects regarding preferences for the Covid-19 booster dose. The sample was stratified into healthcare workers (HCWs) and non-healthcare workers (NHCWs). Chi-squared tests were performed using STATA, with the significance level set at 95%. Results: The returned questionnaires were 1,885 (26.9%), with the majority being HCWs (64.4%). HCWs rated the quality of communication significantly lower compared to NHCWs, who rated it very high (p < 0.05). HCWs also rated the ease of booking the Covid-19 booster dose and access modalities to vaccination significantly lower than NHCWs (p < 0.05). NHCWs expressed a preference for receiving scientific information from Ministry of Health tutorials, while HCWs preferred information from their general practitioner (p < 0.05). HCWs preferred to receive organizational information from healthcare management, while NHCWs preferred information from vaccination physicians (p < 0.05). Additionally, HCWs preferred company operating procedures for disseminating information, whereas NHCWs preferred corporate communications circulars (p < 0.05). Conclusions: HCWs and NHCWs showed differences in perceived quality of communication, ease of access to vaccination services, and preferred sources of information. HCWs rated the quality of communication and access to vaccination services lower than NHCWs. This results suggest the need for tailored communication strategies to effectively reach both groups. Key messages: • Health organizations need to develop targeted communication approaches that address the specific needs and preferences of their employees. • Flexibility and adaptability are crucial to adapt communication methods and channels to strengthen vaccination initiatives and promote public health outcomes.

Background: According to Italian law, citizens are free to choose their preferred place of care across the national territory. This study aims to analyze the associations between patients’ mobility between Tuscany (Italy) and other Italian regions and the complexity of Diagnosis Related Groups (DRGs) provided for these hospitalizations. Methods: A retrospective study was conducted using 2019 Hospital Discharge Cards data of Tuscany provided by the Italian Ministry of Health. The surgical DRGs of each Major Diagnostic Categories (MDCs) were considered according to high specialty (HS) and non-high specialty (N-HS). For each MDCs, patients’ attractions, and escapes to bordering and non-bordering regions with Tuscany were associated with HS and N-HS surgical discharge DRGs by using the Odds Ratio. The analysis was performed using STATA software, and the significance level was set at 95%. Results: For Digestive Diseases, patients from non-border regions were more likely to be attracted to Tuscan hospitals for HS DRGs (OR: 1.37 95%CI: 1.08-1.74; p < 0,05), while for Musculoskeletal Diseases those from non-border regions were less likely to be attracted for HS DRGs (OR: 0.51 95%CI: 0.47-0.56; p < 0,05). For Nervous Diseases (OR: 3.08 95%CI: 2.18-4.37; p < 0,05), for Ear, Nose, Mouth And Throat Diseases (OR: 2.41 95%CI: 1.52-5.03; p < 0,05) and for Hepatobiliary And Pancreas Diseases (OR: 4.55 95%CI: 2.71-7.68; p < 0,05), Tuscan patients were more likely to escape to non-border regions for HS DRGs, while for Musculoskeletal Diseases (OR: 0.76 95%CI: 0.68-0.84; p < 0,05) they were less likely to be admitted to non-border regions for HS DRGs. Conclusions: The results suggest the necessity of establishing mobility agreements between regions, particularly for high-specialty DRGs. In fact, the provision of mobility care economically benefits the receiving (creditor) region, which provides the medical service, but is not advantageous to the patient’s region of residence (debtor). Key messages: • Monitoring mobility flows is critical to improve identify possible lack of supply of resources. • There is a need to develop interregional mobility agreements to ensure better cooperation between different regional health systems.