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Background Violence against healthcare workers (HCWs) has gained increasing attention in recent years, both because it is on the rise and because there is growing concern about these incidents, which are classified as sentinel events by the Italian Ministry of Health. Since little is known about the actual burden of this phenomenon, especially during the stressful COVID-19 vaccination campaign, we decided to explore the problem in our region. Methods Between January and March 2022, in the 1.2 million-inhabitant Friuli Venezia Giulia region (Italy), we conducted an anonymous online survey to collected data on episodes of violence and their consequences for HCWs. Data from validated tools assessing characteristics of violent episodes and post-trauma impact were analyzed in conjunction with socio-demographic data of respondents. Results 200 HCWs participated in the survey, most of whom were women (72%), worked as nurses (107) or doctors (71), and had a mean age of 47 years. More than half of them (59%) reported at least one episode of violence, mainly in the form of a verbal assault (64%); there were no differences between victims. In 72 cases, these incidents affected the HCW’s private life, mainly disturbing sleep or concentration (68%). Most HCWs stated that inadequate communication was a trigger for the violence (97%). Although 80% of HCWs would readily report any violent incident, to improve the situation they called for certainty of action against the perpetrator (87%), more organizational support (85%), standard procedures (75%) and self-defense courses (75%). Conclusions Violence in COVID-19 vaccination campaign appears to be common and to affect both the personal and professional lives of HCWs. Improvements at the institutional and personal level could help to address this problem that affects the health workforce. Key messages • Given the growing public debate, violence in healthcare settings is an important issue that needs to be addressed in the coming years. • Assessing workplace violence and its associated risk factors will help focus on the strategies that can be usefully employed to prevent it in the future.

Introduction The current pandemic scenario may cause psychological distress among healthcare workers (HCWs). Although several studies highlighted this issue as particularly affecting frontline HCWs, no data are available regarding professionals dealing with the governance of healthcare organizations. This study aims to assess the psychological impact of COVID-19 on healthcare leaders (HeLs). Methods A cross-sectional study was carried out between October and November 2020, among HeLs working within Friuli-Venezia Giulia healthcare system (Italy). HeLs included: heads of surgical or medical department, deans of hospital, heads of doctors and nurses working at regional level or in hospital/community settings. We collected demographic data and assessed the presence of depressive (DS) and anxiety symptoms (AS), perceived stress (PS) and insomnia using internationally validated tools. Relationship between mental health outcomes and professional role was analysed using nonparametric tests. Results A total of 48 HeLs participated; their mean age was 53.4±7.9, women were 56.3%. Most (45.8%) were heads of department, 16.7% deans of hospital, 8.3% heads of doctors, 29.2% heads of nurses. The majority (60.4%) worked in hospital setting, 22.9% in the community and 16.7% at regional level. The prevalence of DS and AS was 14.6% and 12.5%, respectively. Moderate insomnia was found in 12.5% of HeLs, while severe insomnia in 6.3% of them. The 45.8% of HeLs showed moderate level of stress, whereas 4.2% high level. PS was significantly higher among deans of hospital. Moreover, lower PS correlated with lower DS, AS and insomnia (p < 0.05). Conclusions The high level of perceived stress, insomnia, depressive and anxious symptoms experienced by HeLs shows another issue of the COVID-19 pandemic psychological impact. Considered the key role of HeLs in leading healthcare organizations over the current crisis, mental health of these professionals is a major issue that needs higher attention. Key messages Psychological impact of COVID19 not only affects frontline HCWs, but also the professionals who are leading healthcare organization through the crisis. Promotion of mental well-being among HCWs should be improved at all levels of healthcare organizations, ensuring a healthier workplace for all professionals working for public health.

Background To prevent flu spread, Italian healthcare workers (HCWs) are annually recommended and given free flu vaccination. This measure of healthcare system protection resulted to be fundamental during COVID-19 pandemic to prevent staff shortage issue. Being the minimum coverage target set at 75%, we decided to evaluate vaccination adherence among HCWs at Udine University hospital. Methods The 2020 vaccination campaign started 4 weeks earlier than usual and was based on a multiple offer strategy including a daily-dedicated clinic, in-ward administrations along with wide vaccination agenda promotion within hospital. The prevalence and the characteristics of vaccinated HCWs were compared with the same 2019 data. Results During 2020, 1868 out of 3839 (48.7%) of HCWs were vaccinated, compared to 29.1% in 2019 (p < 0.0001). Doctors and residents were the most vaccinated categories in both years, being respectively 64.7% and 67.2% in 2020 vs 45.0% and 52.4% in 2019 (p < 0.0001). Midwives showed the best improvement in coverage passing from 44.4% to 20.4% (p = 0.0096). HCWs working in emergency areas and intensive care unit reached the highest adherence in 2020 (61.3%) and the best improvement compared to 2019 as well (37.9%; p < 0.0001). Conclusions Even if the target was not reached, strategies adopted for 2020 vaccination campaign significantly increased HCWs adherence. COVID-19 contribution in this achievement cannot be ruled out, possibly representing a strong reinforcing element for HCWs awareness towards infectious disease prevention. Key messages Despite the improvement in vaccination adherence, HCWs flu vaccination coverage still remains a concerning issue to be addressed. Increased flu shot adherence reached during COVID-19 pandemic should be not only a target to be maintained but even improved next year getting closer to herd immunity.

Introduction Clinical record (CR) is an appropriate source for adverse events (AEs) detection and Italian law requires its compilation. Its completeness is used as an indicator of the quality of care provided and offers guidance on system changes to improve professional practice. This study aimed at assessing the completeness of CRs, describing AEs' rate and triggers, and investigating the relationship between CR completeness and the occurrence of AEs. Methods A retrospective review of CRs was conducted, randomly selecting patients discharged from Internal Medicine (IM), General Surgery (GS) and Obstetrics (O) between June and September 2020 at the Academic Hospital of Udine (Italy). The completeness of CRs was assessed using a 65-items checklist developed by the hospital Quality Unit. Triggers and rate of AEs were detected by using Global Trigger Tool. Relationship between AEs and completeness of CR was analyzed using nonparametric tests. Results Among 93 reviewed CRs, 91.4% were from the GS, 5.4% from IM and 3.2% from O. Patient mean age was 64.6±18, women were 51.6%. The average completeness of CRs was 50.4% [30.4%-83.5%]. Identified triggers and AEs were 125 and 29 respectively, with at least one AE every 23.7% admissions, 31.2 AEs per 100 admissions and 40 AEs per 1000 patient-days. The most frequent AEs were surgical damage (51.7%; 15) and hospital-acquired infection (24.1%; 7). Hospitalization length for patients with at least one AE was 12.6 days, whereas it was 6.3 days without AEs. A significant positive correlation (R = 0.36; p < 0.001) was found between length of hospitalization and number of AEs. The increase in CR completeness is associated with the decrease of the total number of AEs (R=-0.18; p = 0.083). Conclusions These findings suggest a direct association between the number of AEs and the length of hospital stay. The correlation between CR completeness and AEs suggest that patient safety could benefit from the improvement of clinical record compilation. Key messages More studies are needed to understand if the occurrence of AEs to patients may cause a prolonged length of hospitalization. A better compilation of CRs should allow to reach a more effective communication between healthcare workers, creating a work environment less prone to errors and AEs.

Background Adverse patient safety events (AEs) can negatively impact on healthcare workers (HCWs) by causing emotional distress and affecting professional ability. The challenge of healthcare organizations is to support HCWs involved in AEs. This study aims to investigate the second victim phenomenon in a large Italian Academic Hospital (AH). Methods A cross sectional survey was conducted from June to November 2019 involving all HCWs working at the AH of Udine. HCWs' demographic characteristics and answers to the Second Victim Experience and Support Tool, Italian version (IT-SVEST; 29 items representing 7 dimensions and 2 outcome variables; Likert-scale: 1-5) were collected. Higher scores indicated a greater negative impact of the AEs and a perceived inadequacy of support resources. Median (M) and interquartile range (IQR) were assessed for each item. The agreement (AGR) (respondents with a mean score ≥4) was assessed for each dimension. Relationship between items score and demographic aspects was analyzed with non-parametric tests. Results A total of 349 HCWs joined the survey. Women were 79.4% and mean age was 39.4±10.7 years. 58.7% of respondents referred to be involved in a AEs. Lots of HCWs expressed feelings of psychological distress (AGR=26.9%) and less experienced HCWs were more affected by feelings of shame than senior ones (M = 4, IQR=1.5 vs M = 3, IQR=2; p < 0.01). Physical distress (AGR=10.9%) and professional self-efficacy (AGR=11.8%) did not had a great impact on HCWs, but younger (M = 3, IQR=2 vs M = 2, IQR=2; p < 0.01) and female (M = 3, IQR=2 vs M = 2, IQR=2; p < 0.01) HCWs were more inclined to question their skills. Support services offered by Hospital organization may be improved (AGR 8,9%). Conclusions Psychological impact of the AEs is relevant in our cohort and less experienced and female HCWs resulted more inclined to doubt their professional abilities when involved. Improvements in support resources should be desirable to create a safer working environment. Key messages HCWs’ psychological dimension and perceived professional self-esteem can be negatively affected by adverse events, especially for less experienced and female professionals. Healthcare organizations need to develop and to implement a second victim support program designed to provide emotional, psychological and professional support for HCWs.

Background Incident reporting (IR) is a system of spontaneous and voluntary reporting of events, important for assessing safety risks and for improving safety and quality of care. Since Covid-19 pandemic led to a change on the hospital organization, related to an overload of work and an increase of pressure in the wards, this study aims to evaluate the impact of Covid-19 on IR and on safety culture. Methods This retrospective study analyzed the data of IR in 2019 and 2020 in the academic hospital of Udine. Number of IR, severity of the events (near miss, events with no harm and events with harm) and IR'S topic were compared. Inappropriate IR were excluded from severity analysis. The chi-square test was used for statistical significance. Results IR in 2020 showed a reduction of 17.7% compared to 2019 (1097 vs 1334, p < 0,05). Furthermore, we observed a reduction in near misses (276 vs 390, - 4,81%, p < 0,05) and an increase in events with harm (226 vs. 219, + 4,52%, p < 0,05). Events with no harm showed no significant increase. The analysis of topics revealed an increase in 2020 of problems concerning assessment of patient (+ 4.47%), especially swab's results delays, organizational aspects (+ 4.88%), due to staff reassignment and ward reorganization, and infection prevention and control (+ 4.65%). This increase is significantly associated with Covid-related IR (p < 0,05). Conclusions In 2020 were collected fewer IR than 2019 and with an higher level of severity. This change may be associated to the increased workload of the staff who had less time to report incidents. Nevertheless 2020 showed an increase in reporting Covid-19 related issues concerning delay of diagnostic test, new work condition and infection prevention and control measures. This analysis suggests that the decreased number of IRs and near miss during the first year of the pandemic could represent a reduction in safety culture. Additional data are needed. Key messages Covid-19 disease influenced the safety culture by reducing the number of IR and near misses reported. New Covid-related issues emerged as critical during the pandemic.

Introduction Coronavirus disease 2019 (COVID19) pandemic is the most significant public health threat of the century, a crisis that have been challenging healthcare systems around the world. Assessment of leadership skills is needed in order to identify attributes of successful leadership during public health emergencies. This study aims to highlight the critical role played by healthcare leaders during this pandemic, assessing the most challenging and demanding phases of the health crisis and the characteristics required for a healthcare leader. Methods A cross-sectional survey was carried out between October and November 2020, using online questionnaires, involving medical and nursing leaders working in the healthcare organizations of the Friuli-Venezia Giulia Region (Northeast of Italy). Professionals from hospital, community setting and regional level were asked about the two most challenging phases of the current pandemic among: crisis early recognition, peak of the emergency phase, declining epidemic, long tail. The most important healthcare leaders' skills were investigated among competence, awareness, communication, decision-making, inspiring trust and data interpretation. Results A total of 48 healthcare leaders participated. Women were 56.3%. Mean age was 53.4±7.9. According to the leaders interviewed, the two most challenging phases of such crisis were crisis early recognition (45%) and the peak phase (31%). Lesser important phases were recognized in the declining epidemic (15%) and the long tail phases (8%). Concerning healthcare leaders' skills required to manage with pandemic, the most reported were communication (35%) and decision-making (26%); while lower importance was identified in inspiring confidence (5%). Conclusions The two most challenging phases identified by this study suggested the importance of public health surveillance and monitoring systems. Communication appeared a critical success factor for leaders in public health emergencies. Key messages Early recognition of the crisis and the emergency peak management are considered the most challenging phases of the COVID19 pandemic by healthcare leaders. Ability to communicate and decision-making emerged as the two most important crisis skills, and should be included among public health leaders core competencies.

Background Safety of care is an essential aim of a healthcare system, even during a pandemic. Incident reporting (IR) is an important safety tool to identify system failures. This study evaluates the impact of SARS-COV-2 pandemic on IR trend in the COVID-19 wards of an Italian Academic Hospital (AH) in Italy. Methods The study analyzed the IR submitted by the wards of Infectious Diseases (ID), Intensive Care Unit (ICU), Pneumology (P) and Emergency Room (ER) of the AH of Udine from 2016 to 2020. For each ward, IR of 2020 were compared to IR of 2016-2019 period, expressed as the mean value. The IR's topics of ER unit, classified according to the International Standards of Patient Safety, were compared between 2019 and 2020. Variation in reporting was assessed using Chi-square tests. Results During 2020, 180 incidents were reported, 81.7% of which submitted by ER unit. Three wards showed a decrease in reporting compared to 2016-2019 period: -18% (7vs8,5) for ID unit, -26% (16v21,7) for ICU and -44% (10vs18) for P unit. ER unit, instead, showed a great IR increase (147vs49; +200%). Considering the reporting from 2016 to 2019, 196 out of 389 (50.4%) of IR came from ER unit. Analyzing the difference in reporting in ER unit between 2019 and 2020, the IR topics regarding “Delay in execution and reporting exams” increase from 2 to 21 (p < 0,05), “Lack of human and/or instrumental resources” from 4 to 29 (p < 0,05) and “Prevention and Control of Hospital Infectious” from 0 to 13 (p < 0,05). Conclusions ER unit showed a higher attitude in reporting than the other considered wards, especially during the COVID-19 period, recognizing IR as an important tool to highlight critical issues. This aspect may reflect the stronger safety culture already present in this unit. SARS-COV-2 pandemic stressed in ER needs of human resources to cope with reorganization determined by COVID-19, rapid covid-test results for the patient's care path definition, implementation of infection control procedures. Key messages A solid safety culture may contribute to maintain high levels of IR even while during challenging times for healthcare systems. Difference in reporting among Covid wards could be explained by a different level of Safety Culture.

Background The excessive amount of information (infodemic) about SARS-COV2 is a global challenge for healthcare authorities in tackling misinformation. Aim of the study was to investigate SARS-COV2 global and Italian web search amount made through a reliable information source during 2019-20 SARS-COV2 epidemic. Methods From December 15th, 2019 to February 23rd, 2020, we used Google Trends to analyze global changes in the volume of searches about “Coronavirus” in relation to reliable sources: “World Health Organization”, “WHO” and the Italian equivalents of “Ministry of Health” and “National Institute of Health”. Primary searches and associated queries (AQs) were analyzed by nation and Italian Region. Results Global interest on “Coronavirus” progressively rose from mid-January, with 2 peaks on days 28th and 31st, fell on February 20th and rose again until day 23rd. “WHO” searches fluctuated with no clear pattern but increased on January 26th and February 3rd. 'WHO' term was among the most frequent “Coronavirus” AQs and viceversa. Singapore, Italy and New Zealand were the most interested nations in “Coronavirus”, while China was at first place in “Coronavirus+WHO” searches. In Italy from January 21st interest in “Coronavirus” gradually increased, with peaks on days 28th and 31st and a higher peak on February 21st. The other terms showed a fluctuating trend, with peaks on January 31st for “WHO” and “Ministry of Health” and on February 21st for all of them. “Coronavirus” was most frequently AQ to “Italy” and “China”, while AQs for the other terms were “Coronavirus” and “WHO official website”. The most interested Italian Regions for “Coronavirus” and “Coronavirus+WHO” were Lazio and Friuli Venezia-Giulia, respectively. Conclusions Interest in SARS-COV2 globally increased during the considered period, especially within most affected areas. The associations between terms thus highlighted seems to confirm that the general population relies on trustworthy information sources. Key messages Infodemic can be at the same time a danger and an opportunity during global and local health emergencies. Health systems should take advantage of current search flow in order to foster reliable information sharing.

Background ”Second victims” are defined as “healthcare workers (HCWs) involved in an unanticipated adverse patient event, who experienced professional and psychological distress”. The Second Victim Experience and Support Tool (SVEST) is a survey developed and validated in the United States, which describes the experience of second victims. This study aims to perform the cross-cultural adaptation of the SVEST and to evaluate its psychometric characteristics in the Italian context. Methods The translation and cross-cultural adaptation process was performed according to the World Health Organization’s guidelines, from March to May 2019. Then HCWs involved in direct patient care (a potential second victim) were asked to complete the Italian version of SVEST in a validation survey, from June to November 2019 at the Academic Hospital of Udine. SVEST consists of 29 items, divided into 7 dimensions, 2 outcome variables and 7 support options. The IT-SVEST was assessed for internal consistency through Cronbach’s α, for content validity with Content Validity Index for Scales (S-CVI) and for Item (I-CVI) and for construct validity with Confirmatory Factor Analysis (CFA). Results Collected surveys were 349. Women were 79.4%. Nurses were 40.1%, 18.9% were doctors and 8.6% were residents. HCWs involved in a patients’ adverse event were 205 (58.7%). Out of these, 66.3% were near misses. The internal consistency of the instrument was adequate in its overall evaluation with Cronbach α = 0.88 (95% C.I.=0.86). S-CVI was 0.94 and I-CVI was 0.70. The CFA results showed a good model fit for the nine-factor structure (chi2=676.18, 327 df, p Conclusions The Italian version of the SVEST (IT-SVEST) can be used to evaluate second victim experiences, demonstrating adequate validity, reliability and good psychometric properties. Key messages Healthcare institutions need an instrument that can direct efforts to prevent and reduce the second victim experience. IT-SVEST is a reliable and valid instrument to obtain accurate information on second victim experience.

Issue Incident reporting (IR) is an important tool to assess potential or current problems within health care facilities. To increase the number of IR should be an important issue of the risk manager. In the academic hospital Santa Maria della Misericordia (SMM) of Udine, in North-east of Italy, IR were anonymous paper forms handwritten by health-care workers (HCW) and sent to Clinical Risk Management by internal mail. Digitalization was carried out aiming to increase IR, making it simpler, more direct and perceived as more anonymous by HCW. Description of the problem January 1st 2019 the digitized system was initialized, between January and March two training sessions for HCW were carried out and from the 1st April HCW began to send IR with the new application which was installed on every hospital's PC. The objectives were to push HCW to report more, mostly on their own wards' incidents, and to receive complete IR through the insertion of some mandatory information fields. Results Comparison between the period from 1st April to 31th December 2018 and from 1st April to 31th December 2019 showed an increase of 22,6% of IR (from 678 to 831), an increase of 11,2% (from 331 to 368) of IR regarding problems with other wards or services and an increase of 33,4% (from 347 to 463) of IR regarding their own wards' incidents. Lessons Digitalization seems to be appreciated by HCW despite they are forced to give more information due to the mandatory fields. This could be explained considering that a direct incident reporting system ensures privacy of the HCW which feels more warded also when he reports an internal problem of his own ward. Finally, mandatory fields facilitate risk management work giving all the relevant information about the incident. Key messages Digital reporting seems appreciated by HCW and could be a mean to increase the number of incident reporting. To guarantee the anonimity of incident reporting should be a priority and every way to make the HCW feel anonymous seems to be appreciated.

Introduction Identification and measurement of adverse events (AEs) is crucial for patient safety in order to monitor them over time and to implement quality improvement programs, testing if they are effective. Global Trigger Tool (GTT) has been proposed as a low-cost method, being also the most effective to detect AEs. This study aims to describe the number of triggers, the rate and level of AEs identified by GTT and the most frequent type of AE. Methods The Italian version of the GTT was used. Ten paper-based clinical records (CRs) randomly selected every 2 weeks were reviewed from January to April 2019 by three independent reviewers (two nurses, one doctor) at the Academic Hospital of Udine. The AEs rates calculated are: AEs per 1,000 patient-days, AEs per 100 admissions, percentage of admissions with an AE. AEs were classified by harm levels according to National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP). Results CRs reviewed were 80. Mean age of the patients was 69.3±16.4, women were 37.5%. Mean hospitalisation was 16.8±15.3. Nine were the cases of re-hospitalisation within 30 days (11.3%). The total number of trigger was 156. AEs were 31, with at least one AE on 27.5% of admissions, 38.8 AEs per 100 admissions and 23 AEs per 1,000 patient-days. AEs with harm level E, F and H were respectively 5 (16.1%), 24 (77.4%) and 2 (6.5%). The most frequent type of AE were hospital acquired infections with 15 cases (48.4%). Conclusions The most frequent type of AE was the hospital acquired infections. Rates and levels of AEs were higher than other international studies, probably because of the limited number of CRs reviewed. Key messages Global Trigger Tool is an effective method to detect adverse patient safety events in order to monitor them over time. The most frequent type of adverse events was the hospital acquired infections.

Background Water healthiness is fundamental in medical facilities. Monitoring Legionella spp. and agar cultures concentration is therefore very important. This study looks into these parameters to examine possible criticalities that could need interventions. Methods We collected 399 Legionella and 82 agar cultures withdrawals between November 2019 and February 2020 from 157 detection points (like taps and showers) in 31 structures of four health districts. Withdrawals referred to the 4 quarters of year 2019 (t1, t2, t3, t4). Legionella values were expressed in colony forming units (CFU)/l; agar cultures in CFU/ml. We performed a non-parametric analysis to compare mean values between districts. We used the statistical software package SAS version 9.4 for Windows, setting the significance level at α = 0.05. Results 45% of structures presented at least one positive withdrawal for Legionella (in six we found positivity in more than 1 quarter). Concerning Legionella concentration, we found significant difference between districts in t2 (p = 0.012) and between wards of one district in t3 (p Conclusions Data provided by this study show that Legionella is rather present in our districts, revealing an association with concentration of CFU in agar. Disinfecting operations should be implemented considering the differences between districts to provide a safe water in every ward. Key messages Water quality monitoring in healthcare facilities is fundamental to provide a safe and healthy environment. Legionella spp. and agar cultures concentrations depend by quarter and spot considered; focused operations should be taken into account to improve disinfection quality.

Issue Despite low healthcare workers (HCWs) vaccination coverage being a risk for hospital outbreaks, vaccine hesitancy is not unusual among HCWs. In Italy vaccinations are strongly recommended for HCWs, but there are few occasions for a dedicated counseling. Aim of the study is to evaluate the effectiveness of a new vaccination service in the academic hospital of Udine (northern Italy) in tackling vaccine hesitancy among HCWs. Description of the problem Available data on HCWs specific antibody titers revealed that in high-risk units, 25% of HCWs were certainly unprotected for at least 1/6 of the vaccine preventable diseases (VPDs): measles, rubella, mumps, varicella, pertussis, hepatitis B; only varicella coverage reached the herd immunity target. Periodic occupational health visit was the only moment to screen for VPDs protection and suggest vaccination, but the following inconvenient procedure of HCWs contacting the vaccination office outside the hospital, often lead to delays or loss. In order to improve vaccination adherence, since June 2019 a dedicated clinic has been set up inside the hospital, making vaccination counseling and administration available every two weeks, with appointments directly given by the occupational doctor. Results From June 2019 to February 2020, a total of 362 appointments were booked for the dedicated vaccination clinic, 69.7% of which actually took place as 252 HCWs actually accessed the service. Hours dedicated to the service activity were 76 hours, distributed over 19 days. Administered vaccination were 322, including 107 MMR (measles, rubella, mumps), 4 MMRV (MMR+varicella), 20 varicella, 64 hepatitis B, 127 DTPa (diphtheria, tetanus, pertussis). Lessons Making the access to vaccination more convenient in term of service location within the hospital and giving the appointment when performing the occupational health visit seems to be helpful in filling the VPDs protection among HCWs gap. Key messages Monitoring immunological status of HCWs and promoting vaccination at occupational health visit would sustain herd immunity protection for susceptible individuals in healthcare settings. The dedicated hospital vaccination clinic and the effective procedure of giving the appointment during the occupational health visit could be helpful in improving HCWs vaccine adherence.

Introduction Healthcare workers (HCWs) can experience psychological distress if involved in adverse patient events, becoming second victims. The aim of this study is to determine the extension of the second victim phenomenon and the preference of the support resources of the HCWs working in the Department of Maternal and Child Health (DMC) at the Academic Hospital of Udine. Methods A cross-sectional survey was carried out from June to November 2019. All HCWs involved in direct patient care working in the three units of DMC [Obstetrics and Gynaecology (OG), Neonatology (Neo), Pediatrics (Ped)] were included. A validated version in Italian language of the Second Victim Experience and Support Tool (SVEST) was used to assess the experience of second victim and the support resources preferred by the HCWs (Likert-scale: 1-5). Agreement of the support options were considered with an overall mean subscale score of ≥ 4.0. The Wilcoxon signed rank sum test was used to calculate the statistically significant differences (p Results The response rate was 44,9% (120/267). Women were 95.8%. Mean age was 38.7±9.7; HCWs from OG were 48.3%, 26.7% from Neo and 25% from Ped. Nurses were 34.2%, 32.5% were obstetrics, 15.8% were doctors and 8.3% were residents. HCWs who experienced adverse patient events were 80 (66.7%). Out of these, 63 (52.5%) were near-miss events. The overall mean score of the first two dimensions of SVEST (”Psychological distress” and “Physical distress”, as representative of the trauma experience) was respectively 3.3±1.0 and 2.3±1.1. The difference between their scores was statistically significant (p Conclusions The study highlights that HCWs of the DMC are frequently involved in adverse patient events. Psychological distress was significative more impactful than physical distress. The majority of HCWs preferred a peer for colleagues support. Key messages SVEST is an instrument that helps to determine the support resources preferred by HCWs in order to develop a support program for second victim. A peer for colleagues support is the support resource preferred by the HCWs working in the Department of Maternal and Child Health.

Issues Mycobacterium chimaera bacterium, firstly identified in 2004, is mainly present in drinking water but is generally not harmful for human health. Incubation period ranges from 3 to 72 months, with a median of 17 months. Clinical signs are fever, weakness and weight loss. The infection has a lethality rate of 50%. Invasive infections are associated to the use of Heater-Cooler-Devices (HCD) in cardiovascular surgery. Description of the Problem This work reports on an unexpected Mycobacterium chimaera infection case occurred after a time period much longer than what literature reports for both incubation and surgical infection. In January 2007, a 67-year-old man underwent cardiac surgery for an aortic dissection Stanford type A, with implantation of an ascending aorta prosthesis at Udine Academic Hospital (Italy). After a chronic heart failure relapse occurred in September 2018, he developed fever of unknown origins, sepsis, and then he underwent surgery to substitute the vascular prothesis. In January 2019 the clinical condition of the patient got worse and he died in September 2019. Results The first level bacterial culture turned out to be positive for Mycobacteria, so the second level molecular biology test was carried out with GenoType NTM-DR. This analysis revealed a specific positivity for Mycobacterium chimaera. The confirmation test on the Heater-Cooler-Device (HCD) could not be carried out as this device was scrapped since years. Lessons This case report suggests that Mycobacterium chimaera incubation period can be extremely variable. Therefore, when performing differential diagnosis, it should be considered even for those patients who underwent cardiac surgery more than 5 years prior clinical manifestation. We suggest extending the current ECDC's exposure criteria, assuming that incubation period could cover the entire patient's life. Key messages Mycobacterium chimaera can have an incubation period much longer than what is usually described in literature and ECDC guidelines. This report can be considered a starting point to improve the hospital infection control surveillance system in hospitals performing cardiac surgery.

Background Healthcare workers (HCWs) occupational exposure to vaccine-preventable diseases (VPDs) is a great challenge, especially for the risk of disease transmission to patients and general population. Our aim was to explore HCWs occupational exposure management within Friuli Venezia-Giulia (FVG) Region (Italy) in order to identify the most appropriate and equal strategies. Methods In December 2019 we collected data from the 7 acute-care hospitals of FVG. Total number of employees, methods to investigate on potential exposure to VPDs, immunity assumptions and management of occupational exposure were investigated. Results We obtained data from all FVG hospitals, for a total of 14,002 employees (average 2,000; range 551-4,336), including 12,557 HCWs (average 1,794; range 467-3,922). Four hospitals also include students, being academic centers (2) or research institutions (2). All hospitals conduct potential exposure investigation among HCWs, including patients, caregivers, visitors, non-HCW employees, but students are considered in 6/7 hospitals. Immunity of exposed subjects is assumed based on vaccination evidence or serological positivity. Exclusion from work is prescribed to exposed susceptible HCWs in 5/7 hospitals, while workers re-allocation to lower risk wards is required in 4 hospitals; in 2 cases HWCs are asked to wear a mask during their shift. When appropriate, 2 hospitals administer immunoglobulin, whereas a specific procedure for susceptible HCWs exposure was not always available. In 6 cases the exposure of non-HCWs subjects is notified to the occupational doctor or worker manager, and in 1 case serological positivity is directly tested. Conclusions There is heterogeneity in the management of VPDs occupational exposure within FVG, in particular regarding the surveyed categories and the actions required to the exposed subjects. The evaluation of potential adverse outcomes on patients would contribute in designing a more effective preventive strategy. Key messages The adoption of different strategies in the HCWs occupational exposure management could result in potential treatment inequality. Exploring occupational exposure management strategies adopted in hospitals is fundamental to standardize practices.

Introduction WHO stresses the need to implement multi-component interventions to raise coverage among healthcare workers (HCWs). We investigated different HCWs influenza immunization programs within Friuli Venezia Giulia (FVG) Region hospitals (Italy) during 2019-20 flu season with the aim of identifying the most effective strategies to tackle hesitancy. Methods In December 2019 we collected from FVG hospitals: number of employed HCWs, vaccination strategies against flu and refusers management during 2019-20 flu season. We obtained data about HCWs flu vaccination coverage from the regional database; Chi-square test was used to find correlation between strategies and coverage. Results We collected data from 7/7 hospitals for a total of employed HCWs of 12,557 (average 1,794; range 467-3,922); 2 hospitals being academic centers and 2 research institutions. All hospitals promoted flu vaccination using emails, notice on hospital website and posters display; 3/7 organized training courses. Vaccination was always provided within the hospital in a dedicated easy and free access room; most hospitals (5/7) also offered ward on-site sessions, some allowing ward self-administration (3/7) or organizing on demand extra-sessions (2/7). No countermeasures were taken in case of refusal. Regional HCWs flu vaccination coverage resulted to be 24.9% (range 17-33.3). Multi-component intervention including passive and active offer, communication and education activities was confirmed to be significantly associated with higher HCWs flu coverage (OR 1.7; CI 1.6-1.9; p Conclusions Different strategies to foster HCWs vaccination were adopted in FVG Region during 2019-20 flu season. The multi-component approach producing the best results should be further analyzed in order to identify the most effective recipe to be shared both nationally and internationally. Key messages Investigating the relation between HCWs flu immunization strategies and their effect is crucial to identify best practices. A multi-component approach including passive and active offer, communication and education activities seems the most effective way to tackle influenza vaccine hesitancy among HCWs.

Background In Italy, recommended annual influenza vaccination is free to healthcare workers (HCWs) to prevent flu spread. No official data are available on HCWs' vaccination coverage (VC), which minimum target is set at 75%. Aim of this study is to compare 2019-20 and 2018-19 flu vaccination coverage in order to evaluate last year campaign effectiveness. Methods 2019-20 flu vaccination campaign efforts at Udine Hospital (Italy) were improved with the aid of public health residents to tackle HCWs convenience concerns. From October 29th to December 5th 2019, dedicated areas and days were increased, informative course about influenza vaccination (efficacy, benefits and safety) toward HCWs were conducted. Data about HCWs getting their flu shot within the hospital were traced and analyzed, grouping different categories. Results During 2019-20 flu season, vaccinated HCWs were 29.1% (1,169/4,012), while they were 22.7% (955/4,203) in 2018-19 (p Conclusions A significant improvement in vaccination coverage during 2019-20 flu season was reached by the specific vaccination campaign for all categories except midwives. Despite this, the global vaccination coverage is still far from the desired target and more must be done to fill this gap. Evidence of HCWs categories for which this intervention was more effective, could be useful in planning next flu vaccination strategies. Key messages Continuous efforts made by public health professionals in promoting flu vaccination show their effect on healthcare workers flu shot adherence. A planned vaccination agenda and educative course about influenza infection and benefits of vaccination, seem to be good strategies to improve vaccination coverage.

Background Coverage for vaccine-preventable diseases (VPDs) among healthcare workers (HCWs) in Italy remains low, and WHO strongly recommends to tailor immunization programs to tackle hesitancy. Aim of the study was to investigate HCW-specific immunization programs within Friuli Venezia Giulia (FVG) Region in order to plan new common strategies. Methods In December 2019 we collected information about FVG hospitals and HCWs immunization programs conducted within each of them, including: number of HCWs employed, monitored VPDs, immunization assumption, vaccination strategies and refusers management. Results We obtained data from 7/7 hospitals, for a total of 12,557 employed HCWs (average 1,794; range 467-3,922); 2 hospitals are academic centers, while 2 are research institutions. All hospitals have immunization programs for measles, mumps, rubella; the majority for hepatitis B (6/7); 5 for diphtheria, tetanus, pertussis, chicken pox. Presumptive evidence of immunity is established when written vaccination documentation is available or in presence of laboratory evidence. HCWs immunization programs are responsibility of the occupational doctor in most hospitals (6/7). Vaccination promotion strategies include: mail or email personal invitation, training courses, video and notice display on hospital website, reminders. Most hospitals set up a dedicated vaccination service located in a hospital common area (4) or outside the hospital (2); one hospital also offered ward on-site vaccination. For airborne or droplets transmission diseases, refusers are asked to wear a mask during shift in 2 hospitals. Conclusions HCWs immunization programs in FVG Region are heterogeneous, and their specific effectiveness has to be studied yet. This study represents the first step in the process of FVG hospitals engagement in sharing effective actions in order to plan a new regional strategy for HWCs immunization. Key messages The investigation of effective strategies conducted in different FVG hospitals is essential for their scaling-up evaluation. A common regional plan for healthcare workers immunization is needed to tackle hesitancy and reduce infectious risk within hospitals.

Issue Influenza vaccination of Healthcare workers (HCW) has a key role in avoiding flu transmission among patients and HCWs and is annually recommended by health authorities. Despite the 75% target identified by WHO, coverage is still inadequate in many European countries. Description of the problem The Infection Control Team and Public Health Residents of a University Hospital annually cooperate to actively offer flu shots directly in the Units, but in 2017-18 campaign only 12,1% of HCWs took advantage of the service. From July to December 2018 a composite intervention was performed to increase immunization rates. In each Unit a medical doctor and a nurse (midwife for the Obstetrics unit) were identified as Link Professionals (LPs).Two educational meetings with Infectious Diseases and Public Health experts were organized for LPs to deal with their hesitancies and to engage them for the vaccination promotion among colleagues.The calendar (2/week ambulatory + 16 in-ward appointments), tailored to maximise the HCW accessibility, was sent to medical consultants and head of departments, to all physicians, and to head nurses for dissemination. Promotional posters and videos were displayed across the hospital. Results Educational meetings were attended by 130 LPs. A total of 772/3420 HCW took advantage of the 2018-19 active campaign (22,6%), with a significant increase from the previous year (+10,4%; 95%CI 8,7-12,2; p < 0,001). The immunization rates raised in all HCWs categories: 279/660 doctors (it was 167/660 in 2017-18; +17.0%; 95%CI 11,9-21.9; p < 0,001); 303/1615 nurses (150/1615 in 2017-18; +9.5%; 95%CI 7.1-11-9; p < 0,001); 13/43 midwives (2/43 in 2017-18; +25,6%; 95%CI 9.7-40.8; p = 0,002). Lessons Despite the significant increase,further efforts are necessary to reach the WHO target rate. All HCWs categories were positively affected by the multi-modal intervention. LPs seem to play an important role in promoting vaccination among colleagues, in a peer-to-peer trust relationship. Key messages Influenza vaccination rates needs to be increased in healthcare workers for their protection and for patient safety. A well-structured multi-modal intervention programme involving prepared HCW promoters into wards is essential to increase compliance.

Background Perioperative antimicrobial prophylaxis is a key practice to prevent surgical site infection. The Udine Healthcare and University Integrated Trust has defined its features in a specific procedure, available on the hospital Intranet. Compliance with the procedure has been monitored on a semi-annual basis. Methods Between July 2013 and December 2018 15 clinical records per semester for each one of the 16 surgical units were randomly extracted, including ordinary admissions with clean or clean/contaminated surgery. Compliance with the procedure was monitored for all the items considered: drug, dosage, timing of administration, redosing and duration of prophylaxis. A first comparison analysis both between semesters and for longer time frames was performed with the chi-square test; to evaluate the presence of a linear trend all over time (in semestres), the Pearson linear correlation coefficient was calculated; in case of correlation, a simple two-variable linear regression analysis was performed. Statistical significance was assessed for p < 0.05. Results A sample of 2775 records was evaluated. Focusing on the first and last semester of monitoring, overall compliance increased in 9 of the 16 units, although there is a drop, when extending the analysis to the whole sample (72% vs 70.8%) with no statistical significance. Otherwise a statistically significant difference is recorded between the first and the last two years of analysis (p Conclusions Compliance with hospital procedure has substantially improved over time reaching a stable performance value. However the linear regression analysis highlights the need to implement new intervention strategies in order to increase overall compliance to redosing. Key messages Overall compliance with hospital procedure has improved over time. Results highlight the need to implement new intervention strategies.

Although WHO project “Clean care is safer care” was introduced many years ago in our hospital, Hand Hygiene (HH) practice shows low compliance level in some wards at increased risk of Healthcare Associated Infections (HAI).

Despite scientific and technological advances, Legionella continues to be a major threat to patients in healthcare settings. To be effective the control of Legionella need a competent attention based on a correct risk assessment and on consequent operative choices.