ICA General Information

ICA  General Information

   Below we present the characterizing aspects of infections related to care and a glossary (pdf 70 Kb) of the terminology most frequently used in Ica.

What are Ica

   Infections related to care are infections acquired in the hospital or in other care settings (residential long-term care facility, outpatient clinic, dialysis center, day surgery, home), related to the episode of care (IE not clinically manifest or incubating at the moment of the beginning of the assistance episode itself). Patients are mainly interested, but more rarely they can also involve health workers, students, voluntary assistance personnel.

Main characteristics of Ica

   Include a wide variety of infectious complications linked by the existing association with a specific care episode

  The classification of an infection as related to assistance is based exclusively on the temporal relationship existing between infection and episode of assistance

   Some infections occur frequently after discharge from the hospital (surgical wound infections, neonatal infections, maternal mastitis, implant infections of foreign bodies, hepatitis)
include exogenous infections (transmitted from the outside) and endogenous infections (endogenous flora of the patient)

   Include preventable infections and infections that cannot be prevented at the current state of knowledge

   They do not include simple colonization's (presence of microorganisms on skin or mucous surfaces in the absence of clinical signs of disease or immunological response).

How frequent and preventable ICAs are

   In the panorama of potential risks to patient safety attributable to health care, they play a leading role, because they are frequent, have a high clinical and economic impact and because they can be avoided by adopting measures of proven efficacy. These are the main epidemiological data on care-related infections:

   The frequency with which an infectious complication appears is on average 5-10% in patients hospitalized, 5% in patients resident in facilities for the elderly and 1% in patients assisted at home
5-10% of infectious complications manifest themselves epidemically
infections sustained by antibiotic-resistant microorganisms are increasingly common
for sepsis and pneumonia an attributable mortality of 20-30% is estimated
out of 100 infections associated with healthcare, on average 20% are preventable, with significant differences depending on the type of infection and the context (the preventable fraction varies from 10 to 70% in different studies).

What are the infections?

    The most frequent types of infections, which together represent around 80% of all observed infections, are:

urinary tract infections
surgical site infections
respiratory tract infections
systemic infections (sepsis, bacteremia).

    The most frequent are urinary infections, which alone account for 30-35% of all care-related infections. However, the relative importance of each infection location varies over time, in different care settings and in different patient subgroups. Systemic infections are becoming more and more frequent, as a consequence of a gradual increase in risk factors responsible for these infections, such as the patient's intrinsic risk conditions, the use of antibiotics and the use of intravascular catheterization.

The main risk factors

   Numerous factors can increase the risk of contracting a care-related infection, among which the main ones are exposure to invasive diagnostic or therapeutic procedures and the presence of conditions or diseases that increase susceptibility to infections. Exposure to invasive procedures increases the risk of infectious complications for:

   Direct access of microorganisms to normally sterile areas of the body
multiplication of microorganisms due to the favorable conditions that are determined (presence of plastic materials, liquids, creation of niches where microorganisms can grow)
contamination of the aids themselves during production or at the time of use (staff hands).
Consult the sheet (pdf 24 Kb) of invasive procedures, related infections and conditions that can alter the host's defenses.

Responsible microorganisms

   Any microorganism can be responsible for care-related infections and many infections are poly-microbial. Until a few years ago, most hospital infections were supported by gram-negative bacteria; in recent years, on the other hand, the frequency of gram-positive (in particular staphylococcus aureus, coagulase-negative staphylococci and enterococci) and fungus-supported infections has progressively increased. The selection of antibiotic resistant strains is a growing problem. It is a worldwide problem and affects both care-related infections and community acquired infections. In a hospital setting, especially in some departments, it is a very serious problem, due to the progressive selection of strains with multiple resistances, which make the treatment of infections very difficult.

Status of surveillance and control programs in Italy

   In Italy there is no surveillance system for infections, although numerous studies of prevalence and incidence, which affected the entire hospital or some at-risk departments, reported a frequency of hospital infections comparable to that found in the Anglo-Saxon countries, if not, in some cases, superior. On the basis of the indications of the literature and of the multicenter studies carried out in recent years, it can be estimated that in Italy 5-8% of hospitalized patients contract a hospital infection: therefore, it can be estimated that every year, in Italy, they occur from 450 thousand to 700 thousand infections in hospitalized patients, especially urinary tract infections, followed by surgical wound infections, pneumonia and sepsis.

   Since potentially preventable hospital infections account for about 30% of those arising, it can be estimated that there are between 135,000 and 210,000 preventable infections each year, and that these are the cause of death in 1% of cases (from 1350 to about 2100 preventable deaths in a year). Furthermore, the European Surveillance of Resistant Infections (Earss) showed that Italy is one of the P

Post a Comment