Maria Luisa Fazzina

Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione

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Alessandra Mularoni

Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione

Brigida Corso

Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione

Barbara Ragonese

Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione

Angelo Luca

Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione

Michele Pilato

Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione

Marco Morsolini

Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione

Pier Giulio Conaldi

Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione

Giuseppe Arena

University of Catania

Giuseppe Arena

University of Luxembourg

Elena Conoscenti

Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione

Cooperative Institutions

Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione

Istituti di Ricovero e Cura a Carattere Scientifico

Lombardia Informatica (Italy)

University of Palermo

University of Pittsburgh Medical Center

University of Catania

University of Messina

University of Pittsburgh

University of Pavia

Ri.MED

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How to Improve Patients' Perceived Quality of Sleep During Hospitalization Through a Multicomponent “Good Sleep Bundle”: A Prospective Before and After Controlled Study

Global Journal on Quality and Safety in Healthcare (2022)

Barbara Ragonese Valeria Denotti Vincenzina Lo Re Giovanni Vizzini Brigida Corso

ABSTRACT Introduction Despite sound evidence on the importance of sleep for human beings and its role in healing, hospitalized patients still experience sleep disruption with deleterious effects. Many factors affecting patients' sleep can be removed or minimized. We evaluated the efficacy of a multicomponent Good Sleep Bundle (GSB) developed to improve patients' perceived quality of sleep, through which we modified environmental factors, timing of nighttime clinical interventions, and actively involved patients in order to positively influence their experience during hospitalization. Methods: In a prospective, before and after controlled study, two different groups of 65 patients each were admitted to a cardiothoracic unit in two different periods, receiving the usual care (control group) and the GSB (GSB group), respectively. Sleep quality was evaluated by the Pittsburgh Sleep Quality Index (PSQI) at the admission, discharge, and 30 days after discharge in all patients enrolled. Comparisons between the two groups evaluated changes in PSQI score from admission to discharge (primary endpoint), and from admission to 30 days after discharge (secondary endpoint). Results: The mean PSQI score difference between admission and discharge was 4.54 (SD 4.11) in the control group, and 2.05 (SD 4.25) in the GSB group. The mean difference in PSQI score change between the two groups, which was the primary endpoint, was 2.49 (SD 4.19). This difference was highly significant (p = 0.0009). Conclusion: The GSB was associated with a highly significant reduction of the negative effects that hospitalization produces on patients' perceived quality of sleep compared with the usual care group.

Sleep

Clinical endpoint

10.36401/jqsh-22-1

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Impact of systematic diabetes screening on peri-operative infections in patients undergoing cardiac surgery

Scientific Reports (2024)

Alessandro Mattina Giuseppe Maria Raffa Maria Ausilia Giusti Elena Conoscenti Marco Morsolini

Abstract Detection of high glycated hemoglobin (A1c) is associated with worse postoperative outcomes, including predisposition to develop systemic and local infectious events. Diabetes and infectious Outcomes in Cardiac Surgery (DOCS) study is a retrospective case–control study aimed to assess in DM and non-DM cardiac surgery patients if a new screening and management model, consisting of systematic A1c evaluation followed by a specialized DM consult, could reduce perioperative infections and 30-days mortality. Effective July 2021, all patients admitted to the cardiac surgery of IRCCS ISMETT were tested for A1c. According to the new protocol, glucose values of patients with A1c ≥ 6% or with known diabetes were monitored. The diabetes team was activated to manage therapy daily until discharge or provide indications for the diagnostic-therapeutic process. Propensity score was used to match 573 patients managed according to the new protocol (the Screen+ Group) to 573 patients admitted before July 2021 and subjected to the traditional management (Screen−). Perioperative prevalence of infections from any cause, including surgical wound infections (SWI), was significantly lower in the Screen+ as compared with the Screen− matched patients (66 [11%] vs. 103 [18%] p = 0.003). No significant difference was observed in 30-day mortality. A1c analysis identified undiagnosed DM in 12% of patients without known metabolic conditions. In a population of patients undergoing cardiac surgery, systematic A1c evaluation at admission followed by specialist DM management reduces perioperative infectious complications, including SWI. Furthermore, A1c screening for patients undergoing cardiac surgery unmasks unknown DM and enhances risk stratification.

Glycated hemoglobin

10.1038/s41598-024-65064-7

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Reducing Carbapenem-Resistant Enterobacteriaceae Using the Targeted Solution Tool

Journal of Nursing Care Quality (2022)

Barbara Ragonese Alessandra Mularoni Andrea Valeri Maria Campanella Brigida Corso

Background: Carbapenem-resistant Enterobacteriaceae (CRE) is a worldwide urgent health problem. Hand hygiene (HH) is an effective intervention to reduce the spread of CRE. Local Problem: In 2017, an increase in the rate of health care–associated (HA) CRE colonization was observed in a large multiorgan transplant center in Italy. This study aimed to reduce the HA-CRE colonization rates by improving HH compliance. Methods: A pre-/post-intervention project was conducted from November 2017 through December 2020. Interventions: The DMAIC (Define, Measure, Analyze, Improve, and Control) framework was used to implement the HH Targeted Solution Tool (TST). Results: Hand hygiene compliance increased from 49% to 76.9% after the Improve phase ( P = .0001), and to 81.9% after the second Control phase ( P = .0001). The rate of HA-CRE decreased from 24.9% to 5.6% ( P = .0001). Conclusions: Using the DMAIC framework to implement the TST can result in significant improvements in HH compliance and HA-CRE colonization rates.

Carbapenem-resistant enterobacteriaceae

Carbapenem

Enterobacteriaceae Infections

10.1097/ncq.0000000000000651

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