1040 / Screening and surveillance of tuberculosis in healthcare students and workers

ITALY
Classification of the PSP
Type of Patient Safety Practice Safe
 
Clinical Practice (CP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Infection control / Prevention of surgical site infections
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Topic of the reported practice
Clinical risk management
Aim and the benefit of the Patient Safety Practice
 
To estimate the prevalence of latent tuberculosis infection (LTBI) and calculate
the main risk-factors associated with this condition in a cohort of healthcare students, either attending or not attending medical wards, trained at a large regional university hospital in Italy, a country at low incidence of tuberculosis (TB).
Description of the Patient Safety Practice
 
In a cross-sectional study, students attending the Medical, Nursing, Paediatric Nursing and Midwifery Schools were actively called to undergo the Tuberculin Skin Test (TST). All TST positive cases were also tested with an Interferon-Gamma Release Assay (IGRA) to confirm the diagnosis of LTBI. Data regarding age, sex, nationality, health status and Bacille Calmette-Guérin (BCG) vaccination were collected for risk-assessment analysis.
Out of 881 subjects actively called for TB screening, 733 (83.2%) regularly performed TST. Prevalence of TST positives was 1.4%, and LTBI diagnosis, confirmed by IGRA, was performed in 0.5% of the study sample. BCG immunization (less than 2%) was not associated with a positive TST result. Furthermore, no difference in the risk of developing LTBI emerged between pre-clinical and clinical students, and the main independent variable associated with this status was to be born in a country with a high TB incidence (20 cases per 100,000 population) (adjusted OR= 32.35; 95%CI:2.71-386.73, p= 0.006 for IGRA positivity)

The project is easily transferable/reproducible in other hospitals and universities.
Indeed, it was based on an initial update of the protocols for screening, periodic monitoring and case management of latent tuberculosis infection in health care workers and students on the basis of the information provided by the Ministry of Health.
The screening and periodic monitoring are based upon the use of a cheap and easy-to-use test, the Mantoux screening test, and the collection of anamnestic data of healthcare workers and students who underwent screening.
The project transferability should be further underpinned by a specific Recommendation issued by the Ministry of Health, regarding the performance of such activities on both the healthcare workers and their equivalents, including health professionals in training.
Attachment of relevant written information and/or photos, as appropriate
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Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Institution level
Specific and measurable outcome for the reported practice were defined
Yes
A baseline measurement before implementation of the reported practice was obtained
Yes
A measurement after full implementation of the reported practice was obtained
Yes
Evaluation of a "positive" effect of the reported practice on Patient Safety
The evaluation showed improvements in Patient Safety outcomes
Type of before-and after evaluation
Quantitative
Enclosure of a reference or attachment in case of published evaluation's results
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Health care context where the Patient Safety Practices was implemented
 
Hospital
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
No
Specification of implementation in another health care setting(s)
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Successful implementation's level  of this Patient Safety Practice across settings
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Involved health care staff
 
Physicians
Quality manager
Risk manager
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
No
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
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Point of time in which service user or their reprasentatives' involvement takes place
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Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
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Short description of the service users' level of involvement
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Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
Yes
List of sources where public information is accessible
http://buonepratiche.agenas.it/practicesedit.aspx?id=4486
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
No
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
No
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
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List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
Motivated staff
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
No
Description of used incentives, if any.
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Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
No
Total number of person days required to implement this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
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Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
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Contact information
 
Name: Marzia Tomellini
Country: ITALY
Organisation: ISTITUTO NAZ. PER LA RICERCA SUL CANCRO
E-mail: marzia.tomellini@hsanmartino.it
Phone: There is no specified text here
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