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Background <p>Healthcare-associated infections (HAIs) are a persistent challenge in intensive care units (ICUs), further aggravated by Antimicrobial Resistance (AMR). Although the World Health Organization (WHO) Infection Prevention and Control Assessment Framework (IPCAF) provides a standardized method to evaluate the Infection Prevention and Control (IPC) capacity, limited data are available on its application in Italy and its association with HAI incidence in ICUs. This study aimed to assess IPC implementation within the Italian Nosocomial Infections Surveillance in Intensive Care Units’ network (<i>Sorveglianza Prospettica delle Infezioni Nosocomiali nelle Unità di Terapia Intensiva</i>, SPIN-UTI) using the WHO IPCAF tool, analyze its relationship with HAI and process indicators, and identify key barriers to effective IPC practices.</p> Methods <p>A cross-sectional analysis was conducted in 43 adult ICUs participating in the 2023 SPIN-UTI surveillance programme. Data on HAIs and IPC-related process indicators were collected alongside IPCAF assessments and a targeted survey on implementation barriers. Descriptive statistics, Spearman’s correlation, and Kolmogorov–Smirnov tests were used for analysis.</p> Results <p>IPCAF total scores, calculated for each ICU, ranged from 350.0 to 782.5 (median: 610.0), with 51.2% of ICUs achieving an advanced IPC level. The lowest scores were observed in education, monitoring, and multimodal strategies domains. Common barriers included inadequate human and financial resources. A significant inverse correlation was found between IPCAF scores and the number of reported barriers (ρ = – 0.583; <i>p</i> &lt; 0.001). No significant associations were found between IPCAF scores and HAI incidence, except for a positive correlation between HAI surveillance domain scores and central line–associated bloodstream infections rates (CLABSIs) (ρ = 0.424; <i>p</i> = 0.016). Strong positive correlations emerged between IPCAF domains and key process indicators, such as antimicrobial stewardship, oral decontamination, and catheter care.</p> Conclusions <p>The study shows substantial variability in IPC implementation across Italian ICUs and identifies key areas for improvement. While higher IPCAF scores correlate with better adherence to preventive practices, they do not directly predict HAI rates, possibly due to differences in surveillance sensitivity, lack of correlation with actual incidence, or the subjective nature of IPCAF responses. Strengthening education, staffing, monitoring and feedback systems is essential to enhance IPC effectiveness and patient safety.</p>

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Implementation of infection prevention and control strategies in Italian intensive care units: results from the SPIN-UTI network

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月26日

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  • Martina Barchitta,
  • Andrea Maugeri,
  • Elisabetta Campisi,
  • Erminia Di Liberto,
  • Giuliana Favara,
  • Roberta Magnano San Lio,
  • Fortunato D’Ancona,
  • Antonella Agodi

摘要

Background

Healthcare-associated infections (HAIs) are a persistent challenge in intensive care units (ICUs), further aggravated by Antimicrobial Resistance (AMR). Although the World Health Organization (WHO) Infection Prevention and Control Assessment Framework (IPCAF) provides a standardized method to evaluate the Infection Prevention and Control (IPC) capacity, limited data are available on its application in Italy and its association with HAI incidence in ICUs. This study aimed to assess IPC implementation within the Italian Nosocomial Infections Surveillance in Intensive Care Units’ network (Sorveglianza Prospettica delle Infezioni Nosocomiali nelle Unità di Terapia Intensiva, SPIN-UTI) using the WHO IPCAF tool, analyze its relationship with HAI and process indicators, and identify key barriers to effective IPC practices.

Methods

A cross-sectional analysis was conducted in 43 adult ICUs participating in the 2023 SPIN-UTI surveillance programme. Data on HAIs and IPC-related process indicators were collected alongside IPCAF assessments and a targeted survey on implementation barriers. Descriptive statistics, Spearman’s correlation, and Kolmogorov–Smirnov tests were used for analysis.

Results

IPCAF total scores, calculated for each ICU, ranged from 350.0 to 782.5 (median: 610.0), with 51.2% of ICUs achieving an advanced IPC level. The lowest scores were observed in education, monitoring, and multimodal strategies domains. Common barriers included inadequate human and financial resources. A significant inverse correlation was found between IPCAF scores and the number of reported barriers (ρ = – 0.583; p < 0.001). No significant associations were found between IPCAF scores and HAI incidence, except for a positive correlation between HAI surveillance domain scores and central line–associated bloodstream infections rates (CLABSIs) (ρ = 0.424; p = 0.016). Strong positive correlations emerged between IPCAF domains and key process indicators, such as antimicrobial stewardship, oral decontamination, and catheter care.

Conclusions

The study shows substantial variability in IPC implementation across Italian ICUs and identifies key areas for improvement. While higher IPCAF scores correlate with better adherence to preventive practices, they do not directly predict HAI rates, possibly due to differences in surveillance sensitivity, lack of correlation with actual incidence, or the subjective nature of IPCAF responses. Strengthening education, staffing, monitoring and feedback systems is essential to enhance IPC effectiveness and patient safety.