How to reduce infections and their impact on the health system

14 Apr How to reduce infections and their impact on the health system

The prevention and control of HAIs in all care facilities is essential for reducing their impact and, more generally, for limiting the spread of antibiotic-resistant microorganisms.
One of the crucial points for combating HAIs is to define and implement good care practices and other measures that follow an integrated program that should be customised for each care setting.
Some of the main measures include the correct washing of hands (which is one of the most important and effective), a reduction in unnecessary diagnostic and therapeutic procedures, the correct use of antibiotics and disinfectants, the sterilization of equipment, asepsis during invasive procedures, environmental infection control, the protection of patients with the appropriate use of antibiotic prophylaxis and the administration of recommended vaccinations (whenever possible well in advance to allow for a good immune response), the vaccination of health workers, infection surveillance activities, the timely identification and control of epidemics, patient isolation, the reinforcement of the measures that should anyway be normally taken to avoid transmission between patients.

On the subject of hospital infections, in order to ensure continuous and uniform operability throughout the country, two circulars have been published by the Italian Ministry of Health:
<271>circolare ministeriale 52/1985 – Lotta alle infezioni ospedaliere</271> (ministerial circular 52/1985 – Fight against hospital infections) that recommends starting an infection control program in every hospital, which includes the setting up of a multidisciplinary committee, the setting up of an operational group, and having specialised nursing staff.
The task of coordination and reinforcing professional training programs is entrusted to the Regions
https://www.ccm-network.it/documenti_Ccm/prg_area1/Inf_Oss/Normativa_naz/Circolare52_1985.pdf
<272>circolare ministeriale 8/1988 – Lotta alle infezioni ospedaliere: la sorveglianza</272> (ministerial circular 8/1988 – Fight against hospital infections: surveillance) which specifies standard criteria for the identification and the diagnosis of the various hospital infection sites and methods of surveillance.

It also recommends using, “active” surveillance systems in addition to laboratory data.
https://www.ccm-network.it/documenti_Ccm/prg_area1/Inf_Oss/Normativa_naz/Circolare8_1988.pdf
Over time, various specific documents on the control of HAIs have been issued by the Ministry of Health (such as the <273>Compendium of measures for the control of HAIs</273>) and the <274>Recommendations on the control of nosocomial spread of methicillin-resistant Staphylococcus aureus (MRSA</274>) or related to the prevention of some infectious diseases,<277> which can have a significant impact </277>also in care settings, such as measles, rubella, HIV, TB and vector-borne diseases.

https://www.salute.gov.it/imgs/C_17_pagineAree_4621_listaFile_itemName_0_file.pdf
https://www.salute.gov.it/imgs/C_17_pagineAree_648_listaFile_itemName_0_file.pdf

The importance of the prevention and control of infectious diseases and antibiotic resistance is also indicated in the <278>National Prevention Plan 2014-2018</278> and in the <279>National Antimicrobial Resistance Plan (PNCAR) 2017-2020</279>.

The recommended strategies, in summary, are:
https://www.salute.gov.it/imgs/C_17_pubblicazioni_2285_allegato.pdf
https://www.salute.gov.it/imgs/C_17_pubblicazioni_2660_allegato.pdf

-carry out epidemiological surveillance aimed not only at quantifying the burden of infectious diseases, but also at recognizing the determinants and risks of infection for assessing the impact of prevention interventions

-take preventive actions identified on the basis of their effectiveness in the field and offer them in a timely and homogeneous manner to the population

-consolidate existing surveillance systems (such as SNICh systems, SITIN, SPIN-UTI, national prevalence studies and HAI surveillance) and enable them to provide homogeneous, representative, timely and adequate data
nominate a regional contact person for the surveillance of HAIs

-implement a national HAI surveillance system

-set up a rapid reporting system for<309> alert organisms</309> and epidemic <321>clusters</321>
transmit the data annually to the ECDC and prepare an annual national epidemiological report, which includes the identification of the necessary actions for improvement

-prepare operational protocols for infectious disease emergencies and develop both preventive actions (aimed at reducing risks) and emergency preparedness plans

-carry out activities for communicating with the population and provide training for health professionals, also to maintain citizens’ trust in the health institutions

-carry out coordination and functional integration between the various institutional levels and the various territorial competences for the implementation of preventive measures, the collection and periodic return of information, the systematic monitoring of quality and the impact of the actions taken. (Source </336><343>www.salute.gov.it</343><349>)</349>

https://www.salute.gov.it/