Pillars for prevention and control of healthcare-associated infections: an Italian expert opinion statement

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Abstract

Healthcare-associated infections (HAIs) represent a relevant problem for all healthcare facilities, because they involve both the care aspect and the economic management of the hospital. Most HAIs are preventable through effective Infection Prevention and Control (IPC) measures. Implementation and improvement of IPC programs are critical to reducing the impact of these infections and the spread of multi-resistant microorganisms. The purpose of this Expert Opinion statement was to provide a practical guide for healthcare organizations, physicians, and nursing staff on the optimal implementation of the core components of Infection Prevention and Control, as recommended by a board of specialists after in-depth discussion of the available evidence in this field. According to their independent suggestions and clinical experiences, as well as evidence-based practices and literature review, this document provides a practical bundle of organizational, structural, and professional requirements necessary to promote, through multimodal strategies, the improvement of the quality and safety of care with respect to infectious risk in order to protect the patient, facilities, and healthcare providers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13756-022-01125-8.

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Most cited references 68

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Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society.

Andre Kalil, Mark L Metersky, Michael Klompas … (2016)

It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.These guidelines are intended for use by healthcare professionals who care for patients at risk for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), including specialists in infectious diseases, pulmonary diseases, critical care, and surgeons, anesthesiologists, hospitalists, and any clinicians and healthcare providers caring for hospitalized patients with nosocomial pneumonia. The panel's recommendations for the diagnosis and treatment of HAP and VAP are based upon evidence derived from topic-specific systematic literature reviews.

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Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care.

Derek C Angus, Walter Linde-Zwirble, Jeffrey Lidicker … (2001)

To determine the incidence, cost, and outcome of severe sepsis in the United States. Observational cohort study. All nonfederal hospitals (n = 847) in seven U.S. states. All patients (n = 192,980) meeting criteria for severe sepsis based on the International Classification of Diseases, Ninth Revision, Clinical Modification. None. We linked all 1995 state hospital discharge records (n = 6,621,559) from seven large states with population and hospital data from the U.S. Census, the Centers for Disease Control, the Health Care Financing Administration, and the American Hospital Association. We defined severe sepsis as documented infection and acute organ dysfunction using criteria based on the International Classification of Diseases, Ninth Revision, Clinical Modification. We validated these criteria against prospective clinical and physiologic criteria in a subset of five hospitals. We generated national age- and gender-adjusted estimates of incidence, cost, and outcome. We identified 192,980 cases, yielding national estimates of 751,000 cases (3.0 cases per 1,000 population and 2.26 cases per 100 hospital discharges), of whom 383,000 (51.1%) received intensive care and an additional 130,000 (17.3%) were ventilated in an intermediate care unit or cared for in a coronary care unit. Incidence increased >100-fold with age (0.2/1,000 in children to 26.2/1,000 in those >85 yrs old). Mortality was 28.6%, or 215,000 deaths nationally, and also increased with age, from 10% in children to 38.4% in those >85 yrs old. Women had lower age-specific incidence and mortality, but the difference in mortality was explained by differences in underlying disease and the site of infection. The average costs per case were $22,100, with annual total costs of $16.7 billion nationally. Costs were higher in infants, nonsurvivors, intensive care unit patients, surgical patients, and patients with more organ failure. The incidence was projected to increase by 1.5% per annum. Severe sepsis is a common, expensive, and frequently fatal condition, with as many deaths annually as those from acute myocardial infarction. It is especially common in the elderly and is likely to increase substantially as the U.S. population ages.

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Multistate point-prevalence survey of health care-associated infections.

Shelley Magill, Jonathan Edwards, Wendy Bamberg … (2014)

Currently, no single U.S. surveillance system can provide estimates of the burden of all types of health care-associated infections across acute care patient populations. We conducted a prevalence survey in 10 geographically diverse states to determine the prevalence of health care-associated infections in acute care hospitals and generate updated estimates of the national burden of such infections. We defined health care-associated infections with the use of National Healthcare Safety Network criteria. One-day surveys of randomly selected inpatients were performed in participating hospitals. Hospital personnel collected demographic and limited clinical data. Trained data collectors reviewed medical records retrospectively to identify health care-associated infections active at the time of the survey. Survey data and 2010 Nationwide Inpatient Sample data, stratified according to patient age and length of hospital stay, were used to estimate the total numbers of health care-associated infections and of inpatients with such infections in U.S. acute care hospitals in 2011. Surveys were conducted in 183 hospitals. Of 11,282 patients, 452 had 1 or more health care-associated infections (4.0%; 95% confidence interval, 3.7 to 4.4). Of 504 such infections, the most common types were pneumonia (21.8%), surgical-site infections (21.8%), and gastrointestinal infections (17.1%). Clostridium difficile was the most commonly reported pathogen (causing 12.1% of health care-associated infections). Device-associated infections (i.e., central-catheter-associated bloodstream infection, catheter-associated urinary tract infection, and ventilator-associated pneumonia), which have traditionally been the focus of programs to prevent health care-associated infections, accounted for 25.6% of such infections. We estimated that there were 648,000 patients with 721,800 health care-associated infections in U.S. acute care hospitals in 2011. Results of this multistate prevalence survey of health care-associated infections indicate that public health surveillance and prevention activities should continue to address C. difficile infections. As device- and procedure-associated infections decrease, consideration should be given to expanding surveillance and prevention activities to include other health care-associated infections.

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Author and article information

Contributors

Vincenzo Puro: vincenzo.puro@inmi.it

Journal

Journal ID (nlm-ta): Antimicrob Resist Infect Control

Journal ID (iso-abbrev): Antimicrob Resist Infect Control

Title: Antimicrobial Resistance and Infection Control

Publisher: BioMed Central (London )

ISSN (Electronic): 2047-2994

Publication date (Electronic): 20 June 2022

Publication date PMC-release: 20 June 2022

Publication date Collection: 2022

Volume: 11

Electronic Location Identifier: 87

Affiliations

[1 ]GRID grid.419423.9, ISNI 0000 0004 1760 4142, Risk Management Unit, , National Institute for Infectious Diseases “L. Spallanzani” - IRCCS, ; Rome, Italy

[2 ]GRID grid.9841.4, ISNI 0000 0001 2200 8888, Department of Mental Health and Public Medicine, , University of Campania “Luigi Vanvitelli”, ; Naples, Italy

[3 ]Quality and Risk Management, Nomentana Hospital, Rome, Italy

[4 ]GRID grid.4691.a, ISNI 0000 0001 0790 385X, Department of Clinical Medicine and Surgery, Staff UNESCO Chair On Health Education and Sustainable Development, , University of Naples “Federico II”, ; Naples, Italy

[5 ]GRID grid.413175.5, ISNI 0000 0004 0493 6789, Clinical Microbiology and Virology Unit, , “A. Manzoni” Hospital, ; Lecco, Italy

[6 ]AOU Policlinico S. Orsola-Malpighi, Fondazione GIMBE a IRCCS - AOU, Fondazione GIMBE, Bologna, Italy

[7 ]GRID grid.8142.f, ISNI 0000 0001 0941 3192, Emergency Surgery and Trauma, , Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, ; Rome, Italy

Article

Publisher ID: 1125

DOI: 10.1186/s13756-022-01125-8

PMC ID: 9207866

PubMed ID: 35725502

SO-VID: 71d43597-bf4a-41e9-bd6e-677987fa7cff

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Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 19 October 2021

Date accepted : 7 June 2022

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100006546, Angelini Pharma;

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ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: healthcare-associated infections,infection prevention and control,ipc core components,hand hygiene

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ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: healthcare-associated infections, infection prevention and control, ipc core components, hand hygiene

Pillars for prevention and control of healthcare-associated infections: an Italian expert opinion statement

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Abstract

Supplementary Information

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Karger: Coronavirus / COVID-19

Most cited references 68

Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society.

Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care.

Multistate point-prevalence survey of health care-associated infections.

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Contributors

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Article

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