Box 1.

Annual plan for prevention and control of HAIs

According to the indications of the Lombardy region, an “Annual Plan for Prevention and Control of Healthcare Associated Infections” has been implemented since 2014 at the “Alessandro Manzoni” Hospital of Lecco with the aim of preventing, monitoring, and controlling healthcare associated infections. The plan is drawn up each year by a dedicated working group and approved by the local Hospital Committee for Healthcare Associated Infections. The working group is managed by the Hospital Medical Director and includes the following operators: infection control nurse, microbiologist, infectious diseases specialist, pharmacist, hygiene specialist, quality and risk managers.

The structure of the annual plan is reported below and includes:

• Actions to promote appropriate hygiene measures (e.g., actions to increase the use of alcohol-based formulations for hand cleaning)

• Guidelines for empirical and targeted therapy based on national recommendations and local epidemiology, especially in life-threatening emergencies (e.g., meningitis and sepsis)

• Actions against the spread of nosocomial infections driven by specific local situations

• Monitoring of alert microorganisms, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), ESBL-producing Enterobacterales, carbapenem-resistant isolates belonging to Enterobacterales, Pseudomonas aeruginosa and Acinetobacter baumannii). The process starts from the microbiology laboratory: when an alert organism is isolated an alert is sent via web to the local IPC team

• Monitoring of antimicrobial use as provided by Hospital Pharmacy with a focus on broad spectrum antimicrobials

• Annual one-point survey to establish the local prevalence of HAIs

• Epidemiological reports on circulating pathogens and antimicrobial resistance; in this regard, specific reports are organized separately for different healthcare areas (e.g., medical, surgical and intensive care settings), as well as for outpatients (including patients from long-term care facilities and from the community)

• Educational annual program pointed to an appropriate antimicrobial use for all the hospital personnel

Of note, following the recommendations of the Lombardy Region, special attention has been directed at monitoring carbapenem-resistant Enterobacterales (CRE) and some indicators are verified annually to monitor the trend of this worrying drug resistance, taking into account carbapenemase production (Additional file 1).

Each objective is clearly reported, including results to be achieved, operative times, and specific indicators for evaluating obtained results.

The realization of annual plan objectives is then discussed with healthcare workers during dedicated meetings aimed to present criticisms and improvements.

As a result of activities and actions taken over the years, a more appropriate use of antibiotics has been overall obtained, leading to a lowering in-hospital use of fluoroquinolones and carbapenems. In addition, the good practice of hand hygiene steadily grew, now reaching an overall compliance higher than 70%.