American Journal of Infection Control xxx (2014) 1-2

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American Journal of Infection Control

American Journal of Infection Control

journal homepage: www.ajicjournal.org

Brief report

How Italian hospital Web sites communicate risk management strategies: The case of hospital-acquired infections Maria Serena Gallone MD, Silvio Tafuri PhD, MD *, Vincenza Paola Preziosa MD, Michele Quarto MD, Cinzia Germinario MD Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy

Key Words: Prevention Hand hygiene Surveillance

We aimed to investigate the Web site contents of Italian National Health System structures regarding health care-associated infection (HAI). For each Web site a form inquiring about the availability of information about HAI issues and their prevention was filled in. An HAI section was available in the Web site of 19.3% of facilities. In 1.6% of Web sites this information was available on the homepage. The most frequently reported information was related to infection control practitioners, HAI surveillance systems, and handwashing hygiene. In conclusion, the communication of risks related to clinical practice should be part of risk management systems and should assume a significant position in content strategy activities. Copyright Ó 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

The clinical risk evaluation is an instrument designed by quality management experts to control the safety level reached in health care facilities.1 It was developed because to create a culture of safety, effective strategies and tools are needed to address today’s complex quality challenges and the organizational culture of health care facilities must change.2 To promote a safe culture, unsafe conditions must be reported regularly to ensure early problem resolution before patients can be harmed. Results must be communicated regularly as well.3 However, health care workers of all kinds are exposed to a considerable amount of intimidating behavior that suppresses their willingness to report safety issues.4 The need to communicate risks to public healthdwhether real, alleged, or potentialdis widespread throughout governments, health systems, local authorities, and the private sector.5 Risk communication is an essential component of the larger process of risk analysis and management.6 Hospital-acquired infections (HAI) represent an important part of adverse events in hospitals. Therefore, monitoring procedures are in place in most European countries.7 During 1985 the Italian National Health System (NHS) introduced guidelines on how to organize an effective approach to HAI prevention.8 However data describing how Italian hospitals are organized to prevent hospital * Address correspondence to Silvio Tafuri, PhD, MD, Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy. E-mail address: [email protected] (S. Tafuri). Conflicts of interest: None to report.

infections are still lacking; national and regional figures about the incidence of HAI are not available. Publishing data about HAI is not mandatory and these data are usually communicated only to the heads of the hospital departments involved. The Italian Ministry of Health stipulates that every hospital or health trust must have a Web site to describe its structures and to communicate its activities. Our study aimed to investigate the Web site contents of NHS structures regarding HAI by a quantitative analysis. METHODS In Italy there are 4 different types of public health care facility: research and medical care institutes (IRCCS), general hospitals (AO), university hospitals (AOU), and local hospitals (PO). Every one of them has a Web site. The Web sites of all Italian public health care facilities operative in January 2013 were consulted. The list of health care facilities was taken from the Ministry of Health Web site (http://www.salute.gov. it/servizio/sezSis.jsp?label¼elenchi). For each Web site a form was filled in regarding the following information: type of health care facility, Web site details, availability of information about HAI issues and their prevention on the homepage and within the whole Web site, availability of a discussion forum, and contact information. The data from completed forms were input into a database created in FileMakerPro software (FileMaker Inc, Santa Clara, Calif). Data were analyzed using StataMP 11 software (StataCorp, Cary, NC).

0196-6553/$36.00 - Copyright Ó 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajic.2014.03.012

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M.S. Gallone et al. / American Journal of Infection Control xxx (2014) 1-2

Table 1 Number (proportion) of Web sites with information about health care-associated infection (HAI) issues, arranged by issue and type of health care facility

Information available in Web site

IRCSS (n ¼ 47)

AO (n ¼ 34)

AOU (n ¼ 57)

PO (n ¼ 534)

TOTAL (n ¼ 672)

HAI prevention Hand hygiene Use of alcoholic solution for handwashing hygiene Training courses on HAI HAI surveillance system Results of HAI surveillance activities Infection control practitioners Disinfection means

14 8 6 11 9 3 12 7

8 11 8 6 12 3 15 6

23 18 11 19 24 9 27 12

182 193 156 97 209 23 206 147

227 230 181 133 254 38 260 172

(29.8) (17.0) (12.8) (23.4) (19.1) (6.4) (25.5) (14.9)

(23.5) (32.4) (23.5) (17.6) (35.3) (8.8) (44.1) (17.6)

(40.4) (31.6) (19.3) (33.3) (42.1) (15.8) (47.4) (21.1)

(34.1) (36.1) (29.2) (18.2) (39.1) (4.3) (38.6) (27.5)

(33.8) (34.2) (26.9) (19.8) (37.8) (5.7) (38.7) (25.6)

AO, general hospitals; PO, local hospital; IRCSS, research and medical care institutes; AOU, university hospitals.

RESULTS During January 2013 in Italy 672 health care facilities (47 IRCCS, 34 AO, 57 AOU, and 534 PO) were operative. A Web site update was reported by 428 health care facilities: 365 (54.3%) had updated their Web site during the past 6 months, and 63 (9.4%) had conducted an update during the past year. One hundred thirty facilities (19.3%) had a dedicated HAI section in the Web site. To get to that section a user needed to make an average of 3.3 steps from the homepage (range, 1-6 steps). In 11 Web sites (1.6%) information on HAI prevention was available on the homepage. The most frequently reported information was related to infection control practitioners, HAI surveillance systems, and handwashing hygiene (Table 1). In none of the Web sites was there a discussion forum, although in 663 Web sites (98%) users can send an e-mail message to request information.

and purposes an error of preventable care, is part of a cultural background of resistance of health care institutions to make their limits known, probably out of fear that patients will claim compensation. This attitude is very common in countries with a universal health care system, whereas in countries with an insurance health care system performance assessments are very frequent and they include the publication of statistics on outcomes and errors.10 CONCLUSIONS Despite the fact that during the past decade the focus on clinical governance and the quality of health care have grown exponentially, sharing these issues with customers appears mostly marginal. The communication of risks related to clinical practice should be part of risk management systems and should assume a significant position in content strategy activities.

DISCUSSION

References

Despite the fact that in Italy the first recommendations on HAI surveillance were issued about 25 years ago, nowadays only 1 in 5 health care facilities dedicate a special section of their Web site to HAI; if we focus on AOU this number goes up to 40%, which is better but far from satisfactory. One of the main strengths of our study is its reach, because it covers all public facilities within the Italian NHS. The main weaknesses of our study was the lack of access to restricted areas of the Web sites, thus leading to the impossibility of verifying if there is a flow of information on HAI surveillance between “insiders.” It was also necessary to complete an assessment with qualitative aspects. Although the urge to communicate about HAI issues using the World Wide Web is increasing, other studies are not analyzing the dynamics of clinical risks communication with regard to transparency and participation. The scope of risk communication has traditionally been restricted to communication between operators, or rather the interaction between health care professionals and patients.3 In Italy, a study of risk communication through the analysis of outcomes of coronary artery bypass graft surgery was conducted by the Italian National Institute of Health.9 The publication of these data generated vivid protests, especially among surgeons. Similarly, the insufficient communication on HAIs, which are to all intents

1. Moro ML, Gandin C, Bella A, Siepi G, Petrosillo N. Indagine conoscitiva nazionale sulle attività di sorveglianza e controllo delle infezioni ospedaliere negli ospedali pubblici italiani. [in Italian] Rome [Italy]: Rapporti ISTISAN 01/04; 2001. 2. Chassin MR. Improving the quality of health care: what’s taking so long? Health Aff (Millwood) 2013;32:1761-5. 3. Reason J, Hobb A. Managing maintenance error: a practical guide. Burlington [VT]: Ashgate; 2003. 4. Chassin MR, Loeb JM. High-reliability health care: getting there from here. Milbank Q 2013;91:459-90. 5. Bennet P, Calman K, Curtis S, Fischbacher-Smith D. Risk communication and public health. Oxford [UK]: Oxford University Press; 2010. 6. Health Protection Network. Communicating with the public about health risks. Glasgow [Scotland]: Health Protection Scotland; 2008. 7. Sánchez-Arenas R, Rivera-García BE, Grijalva-Otero I, Juárez-Cedillo T, TocaPorras L, Del Carmen Martínez-García M. Incidence of nosocomial surgical-site infections. Application of National Nosocomial Infections Surveillance System (NNIS) index and description of clinical and biochemical features from patients undergoing first-time ventriculoperitoneal shunt. Circulation 2009;77:13-9. 8. Ministero della Sanità;: Circolare n. 52 del 20/12/1985 ‘Lotta contro le infezioni ospedaliere’; Ministero della Sanita: Circolare n. 8 del 30/01/1988 ‘Lotta contro le infezioni ospedaliere: la sorveglianza’ [in Italian]. Available from: http:// www.ccm-network.it/documenti_Ccm/prg_area1/Inf_Oss/Normativa_naz/ Circolare52_1985.pdf. Accessed December 10, 2013. 9. Seccareccia F, Capriani P, Diemoz S, Taioli E, Tosti ME, Greco D, “Progetto BPAC”. Cross-sectional study of cardiac surgery centers within the “CABG Project” (short-term outcome in patients undergoing coronary artery bypass graft surgery in Italian cardiac surgery centers). Ital Heart J Suppl 2003;4:32-8. 10. Gao GG, McCullough JS, Agarwal R, Jha AK. A changing landscape of physician quality reporting: analysis of patients’ online ratings of their physicians over a 5-year period. J Med Internet Res 2012;14:e38.

How Italian hospital Web sites communicate risk management strategies: the case of hospital-acquired infections.

We aimed to investigate the Web site contents of Italian National Health System structures regarding health care-associated infection (HAI). For each ...
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