Tardivo S, Moretti F, Nobile M, Agodi A, Appignanesi R, Arrigoni C, Baldovin T, Brusaferro S, Canino R, Carli A, Chiesa R, D'Alessandro D, D'Errico M M, Giuliani G, Montagna M T, Moro M, Mura I I, Novati R, Orsi G B, Pasquarella C, Privitera G, Ripabelli G, Rossini A, Saia M, Sodano L, Torregrossa M V, Torri E, Zarrilli R, Auxilia F, SItI Gisio
Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
Management Department, G. Pini Orthopedic Institute, University of Milan, Milan, Italy.
Ann Ig. 2017 Nov-Dec;29(6):529-547. doi: 10.7416/ai.2017.2183.
Healthcare-associated infections (HAIs) are an important issue in terms of quality of care. HAIs impact patient safety by contributing to higher rates of preventable mortality and prolonged hospitalizations. In Italy, analysis of the currently available accreditation systems shows a substantial heterogeneity of approaches for the prevention and surveillance of HAIs in hospitals. The aim of the present study is to develop and propose the use of a synthetic assessment tool that could be implemented homogenously throughout the nation.
An analysis of nine international and of the 21 Italian regional accreditation systems was conducted in order to identify requirements and indicators implemented for HAI prevention and control. Two relevant reviews on this topic were further analyzed to identify additional evidence-based criteria. The project team evaluated all the requirements and indicators with consensus meeting methodology, then those applicable to the Italian context were grouped into a set of "focus areas".
The analysis of international systems and Italian regional accreditation manuals led to the identification respectively of 19 and 14 main requirements, with relevant heterogeneity in their application. Additional evidence-based criteria were included from the reviews analysis. From the consensus among the project team members all the standards were compared and 20 different thematic areas were identified, with a total of 96 requirements and indicators for preventing and monitoring HAIs.
The study reveals a great heterogeneity in the definition of accreditation criteria between the Italian regions. The introduction of a uniform, synthetic assessment instrument, based on the review of national and international standards, may serve as a self-assessment tool to evaluate the achievement of a minimum standards set for HAIs prevention and control in healthcare facilities. This may be used as an assessment tool by the Italian institutional accreditation system, also useful to reduce regional disparities.
医院感染（HAIs）是医疗质量方面的一个重要问题。医院感染通过导致更高的可预防死亡率和延长住院时间，对患者安全产生影响。在意大利，对当前可用的认证系统进行分析后发现，医院中预防和监测医院感染的方法存在很大异质性。本研究的目的是开发并提议使用一种综合评估工具，该工具可在全国范围内统一实施。
对九个国际认证系统和21个意大利地区认证系统进行了分析，以确定为预防和控制医院感染而实施的要求和指标。进一步分析了关于该主题的两项相关综述，以确定其他基于证据的标准。项目团队采用共识会议方法对所有要求和指标进行了评估，然后将适用于意大利情况的要求和指标归为一组“重点领域”。
对国际系统和意大利地区认证手册的分析分别确定了19项和14项主要要求，其应用存在显著异质性。综述分析纳入了其他基于证据的标准。通过项目团队成员之间的共识，对所有标准进行了比较，确定了20个不同的主题领域，共有96项预防和监测医院感染的要求和指标。
该研究揭示了意大利各地区在认证标准定义方面存在很大异质性。基于对国家和国际标准的审查引入统一的综合评估工具，可作为一种自我评估工具，用于评估医疗机构在预防和控制医院感染方面达到最低标准的情况。这可以被意大利机构认证系统用作评估工具，也有助于减少地区差异。
