Burden of Healthcare-Associated Infections in Italy: Disability-Adjusted Life Years

Abstract Background Healthcare-Associated Infections (HAIs) significantly increase adverse clinical outcomes and healthcare costs. In 2016 Italy participated in the second European Centre for Disease Prevention and Control (ECDC) Point Prevalence Survey (PPS) of HAIs and antimicrobial use in acute care hospitals. The aim of this study was to estimate the burden of the 5 most common HAIs in Italy, by evaluating incidence, attributable deaths, Years of Life Lost (YLL), Years Lived with Disability (YLD) and Disability-Adjusted Life-Years (DALYs). Methods National PPS data were used to establish sex- and age-specific incidence of Healthcare-associated Pneumonia (HAP), HA Urinary tract infections (HA UTI), HA Bloodstream Infections (HA BSI) excluding neonatal BSI, Surgical Site Infections (SSI), HA Clostridium Difficile infections (HA CDI). Patients' life expectancy was adjusted according to the severity of underlying conditions using the McCabe score. Following the methodology from the Burden of Communicable Diseases in Europe (BCoDE)-project, an adapted version of the disease models of the BCoDE toolkit was used. Results An overall yearly incidence of 643434 new cases of HAI in Italy was estimated. The aggregate burden of the 5 HAIs was 426411.98 DALYs (86731.03 YLD + 339680.96 YLL), corresponding to 702.53 DALYs per 100000 total population. HA BSI and HAP had the highest burden with respectively 253868.22? and 126038.26 DALYs. The population strata with the highest burden were the ones with McCabe Score 1 for every considered HAI. The age groups with the highest burden were 70-74 for male and 45-49 for female patients. In total, 56% of DALYs were attributable to men and 44% to women. Conclusions This nation-wide study found a significant burden of disease due to HAIs in Italy. Results of this study could be used to guide policy-makers in the implementation of measures aiming to reduce the impact of HAIs. Key messages This study estimated the burden of 5 HAIs in Italy was 426411.98 DALYs (86731.03 YLD + 339680.96 YLL according to 2016 PPS data. Considering the significant burden of HAIs found in this study, infection prevention and control measures should be a Public Health priority in Italy.

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Burden of Healthcare-Associated Infections in Sicily, Italy: Estimates from the Regional Point Prevalence Surveys 2016–2018

Antibiotics ◽

10.3390/antibiotics10111360 ◽

2021 ◽

Vol 10 (11) ◽

pp. 1360

Author(s):

Martina Barchitta ◽

Andrea Maugeri ◽

Maria Clara La Rosa ◽

Claudia La Mastra ◽

Giuseppe Murolo ◽

...

Keyword(s):

Prevention And Control ◽

Control Strategies ◽

Point Prevalence ◽

Infection Prevention And Control ◽

Healthcare Associated Infections ◽

Uncertainty Interval ◽

Life Years ◽

Low Incidence ◽

Healthcare Associated ◽

And Control

An assessment of the burden of healthcare-associated infections (HAIs) in terms of disability-adjusted life years (DALYs) is useful for comparing and ranking HAIs and to support infection prevention and control strategies. We estimated the burden of healthcare-associated pneumoniae (HAP), bloodstream infection (HA BSI), urinary tract infection (HA UTI), and surgical site infection (SSI) in Sicily, Italy. We used data from 15,642 patients aged 45 years and above, identified during three repeated point prevalence surveys (PPSs) conducted from 2016 to 2018 according to the European Centre for Disease Prevention and Control protocol. The methodology of the Burden of Communicable Diseases in Europe project was employed. The selected HAIs accounted for 8424 DALYs (95% uncertainty interval (UI): 7394–9605) annually in Sicily, corresponding to 344 DALYs per 100,000 inhabitants aged 45 years and above (95% UI: 302–392). Notably, more than 60% of the burden was attributable to HAP, followed by HA BSI, SSI, and HA UTI. The latter had the lowest burden despite a relatively high incidence, whereas HA BSI generated a high burden even through a relatively low incidence. Differences between our estimates and those of European and Italian PPSs encourage the estimation of the burden of HAIs region by region.

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Prevention of healthcare associated infections

Manual of Infection Prevention and Control ◽

10.1093/med/9780198815938.003.0007 ◽

2019 ◽

pp. 233-304 ◽

Cited By ~ 1

Author(s):

Nizam Damani

Keyword(s):

Prevention And Control ◽

Bloodstream Infections ◽

Surgical Site Infections ◽

Central Line ◽

Infection Prevention And Control ◽

Healthcare Associated Infections ◽

Tract Infections ◽

Healthcare Associated ◽

Hospital Acquired ◽

And Control

This chapter provides the most up-to-date advice on infection prevention and control (IPC) of the four most common healthcare-associated infections (HAIs). These are: surgical site infections; infection associated with peripheral IV line/cannula and central line-associated bloodstream infections (CLABSIs); catheter-associated urinary tract infections (CAUTI); and hospital-acquired and ventilator-acquired pneumonias (VAP). The chapter examines and summarizes various key elements and discusses implementation of HAI care bundles and high impact interventions which are necessary to reduce these infections.

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Point prevalence of healthcare-associated infections and antibiotic use in a tertiary care teaching hospital in Nepal: A cross-sectional study

Journal of Infection Prevention ◽

10.1177/17571774211035827 ◽

2021 ◽

pp. 175717742110358

Author(s):

Sailesh Kumar Shrestha ◽

Swarup Shrestha ◽

Sisham Ingnam

Keyword(s):

Prevention And Control ◽

Tertiary Care ◽

Antibiotic Use ◽

Point Prevalence ◽

University Hospital ◽

Infection Prevention And Control ◽

Healthcare Associated Infections ◽

Prevalence Survey ◽

Healthcare Associated ◽

And Control

Information on the burden of healthcare-associated infections (HAIs) and patterns of antibiotic use are prerequisites for infection prevention and control (IPC) and antibiotics stewardship programmes. However, a few studies have been reported from resource-limited settings and many of them have not used standard definitions to diagnose HAI precluding benchmarking with regional or international data. This study aims to estimate the prevalence of HAIs and antibiotic use in our centre. We conducted a point prevalence survey in a 350-bed university hospital in Kathmandu, Nepal in April 2019. We reviewed all patients aged ⩾ 18 years admitted to the hospital for at least two calendar days and evaluated for the three common HAIs—pneumonia, urinary tract infection and surgical site infection. We used the clinical criteria by the European Center for Disease Prevention and Control to diagnose the HAIs. We also collected information on the antibiotics used. Of 160 eligible patients, 18 (11.25%) had HAIs and 114 (87.5%) were on antibiotics, with more than half of them (61/114 patients, 53.5%) receiving two or more antibiotics. This highlights the need for effective implementation of IPC as well as antibiotics stewardship programmes in our centre.

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Strengthening infection prevention and control and systematic surveillance of healthcare associated infections in India

BMJ ◽

10.1136/bmj.j3768 ◽

2017 ◽

pp. j3768 ◽

Cited By ~ 8

Author(s):

Soumya Swaminathan ◽

Jagdish Prasad ◽

Akshay C Dhariwal ◽

Randeep Guleria ◽

Mahesh C Misra ◽

...

Keyword(s):

Prevention And Control ◽

Infection Prevention ◽

Infection Prevention And Control ◽

Healthcare Associated Infections ◽

Healthcare Associated ◽

And Control

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The prevalence of and risk factors for healthcare-associated infections in Slovenia: results of the second national survey

Slovenian Journal of Public Health ◽

10.1515/sjph-2016-0033 ◽

2016 ◽

Vol 55 (4) ◽

pp. 239-247 ◽

Cited By ~ 4

Author(s):

Irena Klavs ◽

Jana Kolman ◽

Tatjana Lejko Zupanc ◽

Božena Kotnik Kevorkijan ◽

Aleš Korošec ◽

...

Keyword(s):

Risk Factors ◽

Acute Care ◽

Prevention And Control ◽

Acute Care Hospitals ◽

Healthcare Associated Infections ◽

Prevalence Survey ◽

Cross Sectional ◽

Tract Infections ◽

Healthcare Associated ◽

And Control

Abstract Introduction In the second Slovenian national healthcare-associated infections (HAIs) prevalence survey, conducted within the European point prevalence survey of HAIs and antimicrobial use in acute-care hospitals, we estimated the prevalence of all types of HAIs and identified risk factors. Methods Patients from acute-care hospitals were enrolled into a one-day cross-sectional study in October 2011. Descriptive analyses were performed to describe the characteristics of patients, their exposure to invasive procedures and the prevalence of different types of HAIs. Univariate and multivariate analyses of association of having at least one HAI with possible risk factors were performed to identify risk factors. Results Among 5628 patients, 3.8% had at least one HAI and additional 2.6% were still being treated for HAIs on the day of the survey; the prevalence of HAIs was 6.4%. The prevalence of urinary tract infections was the highest (1.4%), followed by pneumoniae (1.3%) and surgical site infections (1.2%). In intensive care units (ICUs), the prevalence of patients with at least one HAI was 35.7%. Risk factors for HAIs included central vascular catheter (adjusted odds ratio (aOR) 4.0; 95% confidence intervals (CI): 2.9-5.7), peripheral vascular catheter (aOR 2.0; 95% CI: 1.5-2.6), intubation (aOR 2.3; 95% CI: 1.4-3.5) and rapidly fatal underlying condition (aOR 2.1; 95% CI: 1.4-3.3). Conclusions The prevalence of HAIs in Slovenian acute-care hospitals in 2011 was substantial, especially in ICUs. HAIs prevention and control is an important public health priority. National surveillance of HAIs in ICUs should be developed to support evidence-based prevention and control.

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A pre-pandemic COVID-19 assessment of the costs of prevention and control interventions for healthcare associated infections in medical and surgical units in Québec

10.21203/rs.3.rs-608797/v1 ◽

2021 ◽

Author(s):

Eric Tchouaket ◽

Stephanie Robins ◽

Sandra Boivin ◽

Drissa Sia ◽

Kelley Kilpatrick ◽

...

Keyword(s):

Best Practices ◽

Prevention And Control ◽

Healthcare Workers ◽

Infection Prevention ◽

Infection Prevention And Control ◽

Healthcare Associated Infections ◽

Median Cost ◽

Healthcare Associated ◽

The Cost ◽

And Control

Abstract Background Healthcare-associated infections (HCAIs) present a major public health problem that significantly affects patients, health care providers and the entire healthcare system. Infection prevention and control programs limit HCAIs and are an indispensable component of patient and healthcare worker safety. The clinical best practices (CBPs) of handwashing, screening, hygiene and sanitation of surfaces and equipment, and basic and additional precautions are keystones of infection prevention and control (IPC). Systematic reviews of IPC economic evaluations report the lack of rigorous empirical evidence demonstrating the cost-benefit of IPC program in general, and point to the lack of assessment of the value of investing in CBPs more specifically. Objective This study aims to assess overall costs associated with each of the four CBPs. Methods Across two Quebec hospitals, 48 healthcare workers were observed for two hours each shift, for two consecutive weeks. A modified time-driven activity-based costing framework method was used to capture all human resources (time) and materials required (e.g. masks, cloths, disinfectants) for each clinical best practice. Using a hospital perspective with a time horizon of one year, median costs per CBP per hour, as well as the cost per action, were calculated and reported in 2018 Canadian dollars. Sensitivity analyses were performed. Results A total of 1831 actions were recorded. The median cost of hand hygiene (N = 867) was 19.6 cents per action. For cleaning and disinfection of surfaces (N = 102), the cost was 21.4 cents per action, while cleaning of small equipment (N = 85) was 25.3 cents per action. Additional precautions median cost was $4.13 per action. The donning or removing or personal protective equipment (N = 720) cost was 75.9 cents per action. Finally, the total median costs for the five categories of clinical best practiced assessed were 27.2 cents per action. Conclusion The costs of clinical best practices were low, from 20 cents to $4.13 per action. This study provides evidence based arguments with which to support the allocation of resources to infection prevention and control practices that directly affect the safety of patients, healthcare workers and the public. Further research of costing clinical best care practices is warranted.

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A pre-pandemic COVID-19 assessment of the costs of prevention and control interventions for healthcare associated infections in medical and surgical wards in Québec

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-021-01000-y ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Eric Tchouaket Nguemeleu ◽

Stephanie Robins ◽

Sandra Boivin ◽

Drissa Sia ◽

Kelley Kilpatrick ◽

...

Keyword(s):

Best Practices ◽

Prevention And Control ◽

Healthcare Workers ◽

Infection Prevention ◽

Infection Prevention And Control ◽

Protective Equipment ◽

Healthcare Associated Infections ◽

Healthcare Associated ◽

The Cost ◽

And Control

Abstract Background Healthcare-associated infections (HCAIs) present a major public health problem that significantly affects patients, health care providers and the entire healthcare system. Infection prevention and control programs limit HCAIs and are an indispensable component of patient and healthcare worker safety. The clinical best practices (CBPs) of handwashing, screening, hygiene and sanitation of surfaces and equipment, and basic and additional precautions (e.g., isolation, and donning and removing personal protective equipment) are keystones of infection prevention and control (IPC). There is a lack of rigorous IPC economic evaluations demonstrating the cost–benefit of IPC programs in general, and a lack of assessment of the value of investing in CBPs more specifically. Objective This study aims to assess overall costs associated with each of the four CBPs. Methods Across two Quebec hospitals, 48 healthcare workers were observed for two hours each shift, for two consecutive weeks. A modified time-driven activity-based costing framework method was used to capture all human resources (time) and materials (e.g. masks, cloths, disinfectants) required for each clinical best practice. Using a hospital perspective with a time horizon of one year, median costs per CBP per hour, as well as the cost per action, were calculated and reported in 2018 Canadian dollars ($). Sensitivity analyses were performed. Results A total of 1831 actions were recorded. The median cost of hand hygiene (N = 867) was 20 cents per action. For cleaning and disinfection of surfaces (N = 102), the cost was 21 cents per action, while cleaning of small equipment (N = 85) was 25 cents per action. Additional precautions median cost was $4.1 per action. The donning or removing or personal protective equipment (N = 720) cost was 76 cents per action. Finally, the total median costs for the five categories of clinical best practiced assessed were 27 cents per action. Conclusions The costs of clinical best practices were low, from 20 cents to $4.1 per action. This study provides evidence based arguments with which to support the allocation of resources to infection prevention and control practices that directly affect the safety of patients, healthcare workers and the public. Further research of costing clinical best care practices is warranted.

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Healthcare governance and the modernisation of the NHS: infection prevention and control

British Journal of Infection Control ◽

10.1177/175717740200300504 ◽

2002 ◽

Vol 3 (5) ◽

pp. 16-25 ◽

Cited By ~ 6

Author(s):

R Pratt ◽

S Morgan ◽

J Hughes ◽

A Mulhall ◽

C Fry ◽

...

Keyword(s):

Corporate Governance ◽

Prevention And Control ◽

Infection Prevention ◽

Clinical Care ◽

Clinical Governance ◽

Infection Prevention And Control ◽

Healthcare Associated Infections ◽

Healthcare Associated ◽

And Control

Q uality is central to the government's programme for modernising the NHS and clinical quality is at the heart of this agenda. The recent introduction of corporate governance with controls assurance and clinical governance in the NHS has established a framework for providing such excellence in clinical care. Governance applies to all healthcare activities and provides an ideal opportunity for infection prevention and control practitioners to improve the quality of their service and reduce the risk of patients acquiring preventable healthcare-associated infections (HAI). This paper will discuss the introduction of governance in the NHS, describe the key principles of clinical governance and relate these to infection prevention and control.

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