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Objectives The objective of this study is to compare the three methods internationally used for estimating days of hospitalization attributable to hospital infections by applying them to the same population. The methods are: (1) unmatched comparison group; (2) matched control method-based; and (3) Appropriateness Evaluation Protocol method. A study of the prevalence of infections was performed among patients during hospitalization for an ordinary single sampling department. The survey was completed within eight working days between 15 and 24 October 2007. All patients admitted at least 24 hours to the survey day in each department were included in the study, as well as patients discharged/transferred to another hospital or department. During the prevalence study 621 patients were observed, 70 of which with infection (equal to 11.27%). Method The 70 uninfected patients needed for comparison using method 1 were selected through a procedure based on propensity score on demographic variables and clinical trials of patients. The Shapiro–Wilk test was used to verify the normality of quantitative variables. In comparing the three methods Kruskall–Wallis test was used (alpha = 0.05), while comparisons between pairs of methods were performed with the Mann–Whitney test (alpha = 0.017). Results Estimation results of recovery days with infection using the three comparison tests showed that there is a statistically significant difference between the three methods (P = 0.016) and there is a significant difference between 1 versus 3 (P = 0.013) and between 2 and 3 (P = 0.017), whereas between 1 and 2 no difference was found (P = 0.82). Conclusion In conclusion, the three methods are not showing the same estimations and thus may not be exchangeable.

Rationale Although the World Health Organization recommends not using sterile technique for low-risk delivery and literature doesn't report a significant association between clean delivery and higher risk for infection, sterile technique remains a prevalent practice. We conducted our study in the obstetric clinics of two hospitals of Piemonte Region (Italy) that use different operative care models (‘clean’ vs. ‘sterile’). Objectives Aim of the study was to describe practices and procedures used by midwives during delivery, according to the model adopted, and to compare the incidence of perineal infection between use of ‘clean’ versus ‘sterile’ practices for intrapartum care. Methods Prospective cohort study. 200 women for each hospital were included in the study. Health care behaviour and practices performed during the different stages of delivery were observed and recorded on an observation sheet. Follow-up was conducted for 1 month after discharge in order to detect infections of reproductive organs. Results Many differences were described in procedures and health care worker practices between the two hospitals and even among operators of the same ward, but a greater compliance with the theoretical model adopted was described among midwives and physicians of the ‘clean’ delivery model. No infections were detected in either of the two samples of women included in the study. Conclusions From our observations we can conclude that many reasons support the adoption of ‘clean’ technique for low-risk deliveries: reducing inappropriate use of resources and costs for health care, less medicalization, less frequent use of episiotomy and shaving, major compliance of operators with simple and coherent practices and procedures.

Rationale Great emphasis is placed on the need to base assistance activities on efficacy evidence. Nevertheless, it is demonstrated that the mere knowledge of scientific recommendations is not sufficient to determine changes in practice. Many elements can influence the operators' behaviour, so that comprehensive strategies are needed to change wrong or not evidence-based practices. Objectives The aim was to compare the efficacy of two protocol implementation strategies: clinical–organizational integrated audits with feedback and presence of facilitators in the departments versus standard observation. Methods Cluster-randomized, controlled and open trial methods were used. Implementation was investigated for protocols regarding the prevention of pressure lesions and the management of peripheral and central venous catheters. For both protocols, a checklist with the indicators needed for the evaluation was created. The study was divided into five time points. For the initial and final investigation, evaluators filled-in the checklists for both study groups; for the three intermediate investigations, the checklists were self-filled by the operators of the control group, while the operators of the experimental group received the intervention. Results For almost all indicators, the data show an increment in the adoption of correct practices. Nevertheless, the last investigation shows a significant (P