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. 2024 Mar 21;19(3):e0300794.
doi: 10.1371/journal.pone.0300794. eCollection 2024.

Validation of the prevalence to incidence conversion method for healthcare associated infections in long-term care facilities

Costanza Vicentini  1 , Enrico Ricchizzi  2 , Antonino Russotto  1 , Stefano Bazzolo  3 , Catia Bedosti  4 , Valentina Blengini  1 , Dario Ceccarelli  5 , Elisa Fabbri  2 , Dario Gamba  6 , Anna Maddaleno  1 , Edoardo Rolfini  1 , Margherita Tancredi  7 , Carla Maria Zotti  1
Affiliations

Validation of the prevalence to incidence conversion method for healthcare associated infections in long-term care facilities

Costanza Vicentini et al. PLoS One. .

Abstract

Introduction: Residents of long-term care facilities (LTCFs) are a population at high risk of developing severe healthcare associated infections (HAIs). In the assessment of HAIs in acute-care hospitals, selection bias can occur due to cases being over-represented: patients developing HAIs usually have longer lengths of stays compared to controls, and therefore have an increased probability of being sampled in PPS, leading to an overestimation of HAI prevalence. Our hypothesis was that in LTCFs, the opposite may occur: residents developing HAIs either may have a greater chance of being transferred to acute-care facilities or of dying, and therefore could be under-represented in PPS, leading to an underestimation of HAI prevalence. Our aim was to test this hypothesis by comparing HAI rates obtained through longitudinal and cross-sectional studies.

Methods: Results from two studies conducted simultaneously in four LTCFs in Italy were compared: a longitudinal study promoted by the European Centre for Disease Prevention and Control (ECDC, HALT4 longitudinal study, H4LS), and a PPS. Prevalence was estimated from the PPS and converted into incidence per year using an adapted version of the Rhame and Sudderth formula proposed by the ECDC. Differences between incidence rates calculated from the PPS results and obtained from H4LS were investigated using the Byar method for rate ratio (RR).

Results: On the day of the PPS, HAI prevalence was 1.47% (95% confidence interval, CI 0.38-3.97), whereas the H4LS incidence rate was 3.53 per 1000 patient-days (PDs, 95% CI 2.99-4.08). Conversion of prevalence rates obtained through the PPS into incidence using the ECDC formula resulted in a rate of 0.86 per 1000 PDs (95% CI 0-2.68). Comparing the two rates, a RR of 0.24 (95% CI 0.03-2.03, p 0.1649) was found.

Conclusions: This study did not find significant differences between HAI incidence estimates obtained from a longitudinal study and through conversion from PPS data. Results of this study support the validity of the ECDC method.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Lexis diagrams illustrating the study hypothesis.
Diagonal lines represent the length of stay of each patient. Grey lines represent length of stay (LOS) without infection. Black dots represent the occurrence of a healthcare-associated infection (HAI), and black lines represent the duration of infection. Vertical blue lines represent the day of the point prevalence survey (PPS), in which patients are sampled. The study hypothesis is that compared to acute-care settings, where patients with HAIs are over-represented in PPS due to their longer LOS, residents of long-term care facilities developing HAIs are under-represented, as they may have a greater chance of being transferred to acute-care hospitals (ACH) or of dying (red dots).
Fig 2
Fig 2. Diagram illustrating the study design.
HAI, healthcare-associated infection; H4LS, healthcare-associated infections and antimicrobial use in long-term care facilities longitudinal study; LTCFs, long-term care facilities; PPS, point prevalence survey.
See this image and copyright information in PMC

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