Building a benchmark through active surveillance of ICU-acquired infections: the Italian network SPIN-UTI

The Italian Nosocomial Infections Surveillance in Intensive Care Units (ICUs) (SPIN-UTI) project of the Italian Study Group of Hospital Hygiene (GISIO e SItI) was undertaken to ensure standardisation of definitions, data collection and reporting procedures using the Hospital in Europe Link for Infection Control through Surveillance (HELICS)-ICU benchmark. Before starting surveillance, participant ICUs met in order to involve the key stakeholders in the project through participation in planning. Four electronic data forms for web-based data collection were designed. The six-month patient-based prospective survey was undertaken from November 2006 to May 2007, preceded by a one-month surveillance pilot study to assess the overall feasibility of the programme and to determine the time needed and resources for participant hospitals. The SPIN-UTI. project included 49 ICUs, 3053 patients with length of stay >2 days and 35 498 patient-days. The cumulative incidence of infections was 19.8 per 100 patients and the incidence density was 17.1 per 1000 patient-days. The most frequently encountered infection type was pneumonia, Pseudomonas aeruginosa being the most frequent infection-associated microorganism, followed by Staphylococcus aureus and Acinetobacter baumannii. Site-specific infection rates for pneumonia, bloodstream infections, central venous catheter-related bloodstream infections and urinary tract infections, stratified according to patient risk factors, were below the 75th centile reported by the HELICS network benchmark. The SPIN-UTI project showed that introduction of ongoing surveillance should be possible in many Italian hospitals. The study provided the opportunity to participate in the HELICS project using benchmark data for comparison and for better understanding of factors influencing risks.Notes The article by Agodi et al. (first Author and corresponding Author) describes the establishment of the Italian network SPIN-UTI (Sorveglianza Prospettica delle Infezioni Nosocomiali nelle Unità di Terapia Intensiva) as the basis for creation of a national surveillance system for nosocomial infections and reports the results from 49 Italian ICUs. The SPIN-UTI project showed that introduction of ongoing surveillance is possible in many Italian hospitals. The relevance, the international value and the novelty of the paper is highlighted by the fact that the study provided the opportunity to participate since 2005 as collaborating partner, in the HELICS-ICU project (Hospitals in Europe Link for Infection Control through Surveillance) using benchmark data for comparison and for a better understanding of factors that influence associated risks. Moreover the international collaboration with the European Centre for Disease Prevention and Control, Stockholm, Sweden is acknowledge by the inclusion of Carl Suetens, Head of Section for ARHAI, Surveillance Unit, ECDC as a coauthor. The Italian network, which resumed surveillance in 2008 and in 2010, has been included, together with other European networks, in the HELICS-ICU network as a partner of the IPSE project (Improving Patient Safety in Europe), to build a benchmark in a European context, and, for patient-based surveillance, as a partner in the BURDEN project, work package 6 ‘Impact of AMR and appropriate antimicrobial treatment in ICU-acquired infections’, the main objective of which is to study the burden of antimicrobial resistance in healthcare associated infections. Furthermore, the SPIN-UTI network, in 2010, has been acknowledged by the Italian CCM (Centro per il Controllo delle Malattie e Ministry of Health), in the funded national project: “Supporto alle attività di integrazione dei sistemi di sorveglianza delle infezioni correlate all'assistenza e di sorveglianza della tubercolosi”, with the main aim of integrating epidemiological data collected by different Italian networks, with Antonella Agodi Head of one Operative Unit.Besides, the SPIN-UTI network has been quoted in the “Relazione sullo Stato Sanitario del Paese 2009-2010” of the Ministry of Health (Direzione Generale del Sistema Informativo e Statistico Sanitario) (http://www.rssp.salute.gov.it/rssp/homeRssp.jsp).