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

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.

Parental Perception of Children's Mental Health During the Pandemic: Insights From an Italian Cross-Sectional Study.

BACKGROUND: This study explores the impact of the pandemic on children's mental health. It examined the understanding of parents regarding their children's mental condition and their ability to identify issues, 2 years post the outbreak of the COVID-19 pandemic. METHODS: Using a cross-sectional design, 507 Italian parents reported on their youngest child aged between 2 and 17, totaling 507 children. The outcomes focused on were parental perception of children's mental health deterioration, scores on the Strengths and Difficulties Questionnaire (SDQ) above the clinical cut-off, and parental under-recognition of mental health issues. Descriptive analyses and multivariable logistic regression models were executed (significance at p < .05). RESULTS: Parents were 88.1% women (median age 41 years, interquartile range [IQR] = 36-47). Their children were 50.3% female [median age 6 years (IQR = 4-11)]. The data revealed 21.1% of parents perceived a deterioration in their children's mental health, while 44.2% had SDQ scores above the cut-off. Parental under-recognition of mental issues was found in 20.1% of cases. Significant correlations were found between parental perception of deterioration, SDQ scores, and factors like parental mental distress and children's sleep issues. IMPLICATIONS: The findings suggest that schools and verified websites can serve as critical conduits for providing parents with reliable information. By promoting early identification and intervention, such mechanisms can help ensure mental health equity for children. CONCLUSIONS: The research highlights the effect of the pandemic on children's mental health and the issue of parental under-recognition. The results underscore the importance of public health initiatives that enhance mental health information accessibility and reliability for parents.

Implementation of a centralized, web-based surveillance for healthcare associated infections among residents of long-term care facilities in Italy.

Objective: The Italian National Action Plan to contrast AMR identified among its objectives the development and implementation of a national Healthcare-Associated Infection (HAI) surveillance system based on European Centre for Disease Prevention and Control (ECDC) indications, through point prevalence surveys (PPS) of HAIs and antibiotic use in acute-care hospitals and long-term care facilities (LTCFs). We aimed to assess feasibility and appropriateness of proposed tools for a national surveillance system of HAIs and antibiotic use in LTCFs. Study design: Point prevalence survey. Methods: A pilot PPS was conducted between May-June 2022, among 15 LTCFs of 7 Italian regions. Data were collected in a single day in each LTCF, at the LTCF, ward, and resident levels, using a web-based data collection tool developed ad hoc. Data collector teams of each facility were invited to complete a questionnaire investigating opinions on the proposed tools. Results: Among 1025 included residents, the prevalence of residents with at least one HAI was 2.5% (95% CI 1.7%-3.7%) considering all HAIs and 2.2% (95% CI 1.3%-3%) without considering SARS-CoV-2 infections. The prevalence of antimicrobial use was 3% (95% CI 0.2%-4.3%). Overall, most respondents were satisfied with the web-based software, training and protocol, even though some difficulties were reported. Conclusions: A national surveillance network was established, which will facilitate future surveillance efforts. Further studies are necessary to evaluate the impact of the pandemic on HAI transmission and antibiotic use in LTCFs.

Hand Hygiene and Antimicrobial Resistance in the COVID-19 Era: An Observational Study.

Hand hygiene (HH) is one of the most important infection prevention and control strategies at the hospital level. The aim of this study was to evaluate the potential COVID-19 pandemic impact on HH practices and rate of healthcare-associated infections. Data on alcohol-based handrub consumption (AHC) and antimicrobial resistance across 27 Italian hospitals over the period 2017-2021 were considered. Data on Methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Enterobacteria (CRE) were extracted from the antimicrobial resistance regional surveillance system. A significant increase was highlighted, with a peak in 2020 and a partial fall in 2021 for AHC (p < 0.001). The decrease in MRSA rates in 2021 compared to 2017-2019 was significant (p = 0.013). A significant Spearman's correlation between AHC and CRE rates was found (Spearman's ρ -0.646, p = 0.032). This study supports the importance of AHC monitoring and showed that improving AHC was an attainable goal in the COVID-19 era. However, other strategies are needed to maintain the high levels of AHC attained during the pandemic, in order to avoid a progressive drop that has already begun in 2021. Furthermore, our results support the inverse relationship between AHC and infection rates and antimicrobial-resistant bacteria.