Healthcare-Associated Infection and Antimicrobial Use in Long-Term Care Facilities (HALT3): an overview of the Italian Situation

BACKGROUND: The awareness of health care-associated infections (HAIs) and antimicrobial use in Long-Term Care Facilities (LTCFs) is increasing. In 2017 Italy conducted the third national Point-Prevalence Survey as part of the third "Healthcare-Associated Infections in European Long-Term Care Facilities" (HALT3) study. AIM: The aim of this paper is to report the results of the HALT3 study and analyse resident population of LTCFs, implementation of good practices, prevalence of infection and antimicrobial use. METHODS: The survey was designed as a Point-Prevalence Survey (PPS), carried out from April to June 2017. All residents who live 24/7 in the institution were included. All facilities were asked to fill an "Institutional Questionnaire", a "Ward List" with all residents and a "Resident Questionnaire" for those residents presenting signs/symptoms of an active infection and/or receiving an antimicrobial agent. FINDINGS: 418 facilities took part in the study; 24132 residents were eligible, most were over 85 years old, disoriented and incontinent. Prevalence of HAIs was 3.9%; 50% of the institutions declared to have a professional trained in infection control. Only 26.4% of infections were confirmed by a microbiological sample; 26.9% of the isolated microorganisms were resistant at least to one antimicrobial class. 1022 residents received at least one antimicrobial agent and most-prescribed class were cephalosporins. CONCLUSION: The number of infection control and antimicrobial stewardship measures implemented were considerably higher compared to previous studies. This could lead to a reduction of the prevalence of HAIs, antimicrobial use and antimicrobial resistance. Further studies are needed to monitor these aspect