Achieving optimal patient/caregiver satisfaction scores in the pediatric ED is highly dependent on the quality of the interpersonal interaction and communication of ED activities. Wait time and other throughput variables are less important than perceived quality of the health interaction and interpersonal communication. Patient satisfaction has advantages greater than market share and should be considered a component of the care-delivery paradigm.

Introduction: scabies is a contagious parasitic disease which can cause hospital outbreaks, with possible involvement of sanitary staff, and considerable economic and managerial implications. The Policlinico San Matteo of Pavia adopts (since 2005) a protocol for the management of index cases, based on early patient isolation, identification of close contacts, and their prophylactic treatment. We report here descriptive data on reported cases of scabies and on the effectiveness of the protocol. Materials and Methods: retrospective study (2005-2014) of the index cases. For each case, clinical data were collected, as well as information on the healthcare workers who had dealt with the patient within the 6 weeks (maximum scabies incubation period) preceding the diagnosis. Results: 30 index cases were identified: 11 females and 19 males; mean age 60 years; range: 2 months -92 years. 9 patients had been transferred from other health facilities. 11 were immunosuppressed: of these, 3 were suffering from Norwegian scabies (a highly contagious variant). Close contacts included 894 health professionals, mainly nurses, physicians and students; of these, 158 had provided care to patients with Norwegian scabies: 15 (1.7% of the entire sample) were infected. This percentage is below the rates of infection (sometimes > 30%) reported in other case series. Discussion: scabies is a major occupational hazard in hospitals, especially for nursing staff, including students in training. Immunocompromised patients are particularly dangerous, since they are more prone to developing Norwegian scabies. The operative protocol adopted by the Policlinico San Matteo is effective for risk containment.