Hospital-level risk factors for healthcare-associated infections: insight from the Italian PPS Study

Abstract

Abstract Background In 2016-2017, a Point Prevalence Survey (PPS) was conducted by the European Centre for Disease Prevention and Control (ECDC) in 29 European countries to investigate healthcare-associated infections (HAIs) and antimicrobial use. The aim of this study was to identify significant determinants of HAIs at a hospital level according to Italian data. Methods Among variables considered by the ECDC Protocol for the PPS, those with most plausible relationship with HAI occurrence according to the literature were a priori selected. Hence, conceptual causal models were built for each reference variable, by adjusting for an established set of confounders (geographical region, hospital type and number of beds), and also considering the possible interaction of the number of blood cultures per 100 patient-days (a proxy of how thoroughly HAIs are searched). Direct effects were estimated in the form of risk ratios through multivariable log-binomial regression models. Results Data were available for 135 Italian hospitals participating in the survey. Factors with significant impact on HAIs resulted to be: percentage of single rooms (RR = 0.91 for every 5% increase, p = 0.013), presence of a plan for infection prevention and control (IPC, RR = 0.51, p = 0.007), routine production of an IPC report (RR = 0.50, p = 0.001), adoption of measures for HAI prevention (RR = 0.21, p = 0.002) and antimicrobial stewardship (RR = 0.50, p = 0.015). The interaction of the number of blood cultures was significant for the effect of IPC report (p = 0.038), number of measures for HAI prevention (p = 0.037) and antimicrobial stewardship (p = 0.02). Conclusions The results confirm the importance of HAI prevention and antimicrobial stewardship as means of lowering the occurrence of HAIs. Therefore, investigating, testing and correctly reporting the onset and evolution of HAIs is paramount to ensure better understanding of the phenomenon and to provide useful insights to create a safer background for clinical practice. Key messages Adopting preventive measures and antimicrobial stewardship is crucial in lowering the occurrence of HAIs and ensuring safer care. Investigating, testing and correctly reporting the onset and evolution of HAIs is paramount to ensure better understanding of the phenomenon and to enable effective HAI prevention.