Association of hospital/ICU characteristics with HAIs: findings from the SPIN-UTI project

Abstract Background Preventing the spread of healthcare-associated infections (HAIs) in Intensive Care Units (ICUs) constitutes a priority for Public Health. In a country with decentralized healthcare system, the comparison between and within regions might represent a useful approach to identify what hospital and ICU indicators are associated with HAIs. Methods Using data from the SPIN-UTI (”Sorveglianza attiva Prospettica delle Infezioni Nosocomiali nelle Unità di Terapia Intensiva”) network, the present analyses aimed to identify the main hospital and ICU indicators associated with HAI incidence at national level, and to stratify the analyses between Italian regions. Results No associations between hospital/ICU characteristics and HAIs were evident at national level. However, ICUs in Southern Italy showed the highest incidence density of HAIs if compared with those in Central and Northern Italy (p < 0.001). Stratified analyses found a positive association of incidence density of HAIs and total days in ICU in Northern Italy (β = 0.3; SE = 0.1; p = 0.002); a positive associations with ICU size (β = 1.8; SE = 0.7; p = 0.020), total days in hospital (β = 0.06; SE = 0.02; p = 0.037) and total days in ICU (β = 0.5; SE = 0.1; p = 0.006) in Center Italy; a positive association with hospital size in Southern Italy (β = 20.3; SE = 9.4; p = 0.033). Conclusions Although our study confirms that HAIs still represent an important issue in Italian ICUs, there is some variation between regions from Northern, Central and Southern Italy. In general, we found that HAI incidence increased with increasing number of beds in hospital and in ICU, as well as with the the increasing number of patient-days. However, further research is necessary to better understand if additional hospital and ICU characteristics could motivate the observed regional differences. Key messages • There is a large regional variation in the incidence of HAIs in Italian ICUs and hospitals. • This difference that could be motivated by specific hospital and ICU characteristics.

The demand for the digitalisation of public health has been ongoing for more than a decade. The COVID-19 pandemic was the tipping point that accelerated the ideation, implementation, and scale-up of such public health projects. Despite the well-needed push, the same challenges that face every similar implementation will nonetheless be the same if not accentuated. The scope of the presentation is to highlight the difficulties and facilitators that such implementations and evaluations bring forward. We will also see what we can learn as public health professionals to ensure that present and future information systems are well-planned. We have to ensure that they do not succumb to the pressure of well-intended stakeholders who are yearning for such solutions to help their business workflows. This presentation will be enhanced with the lessons learned from implementing, monitoring, and following up on Malta's national contact tracing app and Customer Relationship Management systems based on Microsoft Dynamics 365 technologies that tackled the Test, Track and Trace workflows that were integral to the COVID response in Malta. Digital and data tools are fundamentally changing approaches to health and the design of health systems, but governance models have neither followed nor kept up with the pace of innovation. In response to this challenge, The Lancet & Financial Times Commission on Governing health futures 2030: Growing up in a digital world explores the convergence of digital health, artificial intelligence, and other frontier technologies with universal health coverage to support attaining the SDG 3. Children and young people are crucial groups requiring particular attention to ensure that no one is left behind in achieving universal health coverage and SDG 3 amidst the digital transformation in health. Today, there are 1.8 billion people between the ages of 10 and 24 -the largest youth population in history -90 percent of whom live in developing countries. This cohort represents an unprecedented powerhouse of human potential and digital engagement that could transform health to reach sustainable development goals. This presentation introduces several key findings from the Commission's report which pertain to the governance of (digital public) health futures amidst digital transformations in health. It will highlight how human-centred approaches to health are vital to navigating the digital transformations and maximising their benefits for population health and wellbeing. Further, it will provide an action plan for meaningful youth engagement in the design, development, implementation, and evaluation of digital public health policies, programmes, and services.

Background:
Preventing the spread of healthcare-associated infections (HAIs) in Intensive Care Units (ICUs) constitutes a priority for Public Health. In a country with decentralized healthcare system, the comparison between and within regions might represent a useful approach to identify what hospital and ICU indicators are associated with HAIs.

Methods:
Using data from the SPIN-UTI (''Sorveglianza attiva Prospettica delle Infezioni Nosocomiali nelle Unità di Terapia Intensiva'') network, the present analyses aimed to identify the main hospital and ICU indicators associated with HAI incidence at national level, and to stratify the analyses between Italian regions.

Results:
No associations between hospital/ICU characteristics and HAIs were evident at national level. However, ICUs in Southern Italy showed the highest incidence density of HAIs if compared with those in Central and Northern Italy (p < 0.001). Stratified analyses found a positive association of incidence density of HAIs and total days in ICU in Northern Italy (b = 0.3; SE = 0.1; p = 0.002); a positive associations with ICU size (b = 1.8; SE = 0.7; p = 0.020), total days in hospital (b = 0.06; SE = 0.02; p = 0.037) and total days in ICU (b = 0.5; SE = 0.1; p = 0.006) in Center Italy; a positive association with hospital size in Southern Italy (b = 20.3; SE = 9.4; p = 0.033).

Conclusions:
Although our study confirms that HAIs still represent an important issue in Italian ICUs, there is some variation between regions from Northern, Central and Southern Italy. In general, we found that HAI incidence increased with increasing number of beds in hospital and in ICU, as well as with the the increasing number of patient-days. However, further research is necessary to better understand if additional hospital and ICU characteristics could motivate the observed regional differences.

Key messages:
There is a large regional variation in the incidence of HAIs in Italian ICUs and hospitals. This difference that could be motivated by specific hospital and ICU characteristics.