Infection prevention and control procedures in nursing homes in the piedmont region of Italy: results from two regional surveys (2021–2024)

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Abstract
Background: Infection prevention and control (IPC) in long-term care facilities (LTCFs) is essential to reduce the burden of healthcare-associated infections (HAI) and the spread of antimicrobial resistance (AMR). This paper describes the development of standardized IPC procedures through a stakeholder-informed approach, and integrates results from two regional surveys conducted in Piedmont (first survey 2021–2022; second survey 2024) which assessed the reported availability of written procedure documents in nursing homes and, subsequently, the uptake and perceived utility of the developed standardized procedures. Methods: Two anonymous cross-sectional surveys targeted all nursing homes registered in the Piedmont regional healthcare census. The first survey (December 2021-April 2022) assessed the reported inclusion of 16 IPC procedure domains in facility manuals and the date of last revision. Based on these findings, standardized IPC procedure documents were developed by the University of Turin in collaboration with DIRMEI, regional public health authorities and IPC stakeholders, and were made available online in 2023. A second survey (August 2024) assessed reported uptake, perceived adequacy, missing but useful procedures and overall satisfaction. Descriptive statistics were used. Results: 436/780 facilities responded to the first survey (55.9%). High availability of written procedure documents was reported for hand hygiene (99.1%), isolation for COVID-19 (99.8%) and cleaning/sanitation (98.9%). Lower availability was reported for sterilization (46.2%), bloodstream infection prevention (45.9%), and management of colonized/infected patients for alert organisms (62.0%). Revision dates varied, with many critical procedures updated predominantly in 2020–2022. After dissemination of standardized procedures, 305 facilities (39.1%) participated in the second survey: 99.7% found them adequate, 31.1% reported possessing all procedures already, and 89% provided an overall positive judgment. The most frequently requested/adopted procedures were vaccination prophylaxis (33.8%), laboratory sample management (31.8%), TB control (26.2%) and catheter management (22.0%). Conclusions: This regional initiative identified heterogeneity in IPC procedural documentation in nursing homes and documented high perceived adequacy and usefulness of standardized procedure documents after dissemination. These findings support harmonized regional resources as a structural component of IPC governance in LTCFs. However, the surveys did not assess implementation fidelity, staff adherence, audits, HAI rates, antimicrobial use or AMR outcomes; future work should incorporate objective implementation and outcome indicators.
Funding Information
  • Regione Piemonte (Determinazione Dirigenziale no. 1440 of 30 June 2023)

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