Impact of hospital-related indicators on healthcare-associated infections and appropriateness of antimicrobial use according to a national dataset

Abstract

Healthcare-associated infections (HAIs) represent a major threat in Europe. Infection prevention and control (IPC) measures are crucial to lower their occurrence, as well as antimicrobial stewardship to ensure appropriate use of antibiotics. Starting from Italian national data, this study aimed at: (i) describing IPC indicators, prevalence of HAIs, antimicrobial use and appropriateness of antibiotic use in Italy; (ii) estimating effects of IPC variables on HAI prevalence and on the proportion of antibiotics without specific reason. Based on data collected for Italy during the ECDC PPS-2 Point Prevalence Survey, descriptive statistics were computed at national and macro-regional level. Causal assumption-informed regression models were then built to estimate the impact of structural determinants, staffing parameters and IPC-related variables on HAI prevalence and percentage of antibiotic prescriptions with no reason detailed on medical records, after adjusting for relevant confounders. The Italian frame showed substantial heterogeneity for both outcomes between macro-regions. The percentage of single-bed rooms was the only structural determinant with significant, positive impact on HAI prevalence (OR = 0.91 for every + 5%, p < 0.001), while the prevalence of antimicrobial agents without specified reason was lower in the presence of one more IPC nurse (OR = 0.78, p < 0.001) or one more antibiotic stewardship consultant (OR = 0.67, p < 0.001) per 100 beds. Both outcomes were reduced in the presence of routinely filed IPC plans and reports (p < 0.001), HAI prevention measures (p < 0.001) and post-prescription review (p < 0.01). Our model confirmed the pivotal role of IPC measures and antimicrobial stewardship in contrasting HAIs and inappropriate antibiotic prescriptions. Post-prescription review appeared to be a valuable indicator of antimicrobial stewardship policies.

Keywords: Antibiotic use; Antimicrobial stewardship; Healthcare-associated infections (HAIs); Infection Prevention and Control (IPC); Point Prevalence Survey (PPS); Surveillance indicators.