Analysis and Impact of Infection Prevention Procedures in Long-Term Care Facilities.

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Abstract
Healthcare-associated infections (HAIs) are a significant healthcare complication, with major implications for public health. In the EU/EEA, up to 2.6 million new HAIs cases occur annually, causing significant burdens and economic costs. In Italy, the prevalence of HAIs is rising due to factors like invasive devices, antibiotic resistance, and poor infection control. The aim of this work is to evaluate the effectiveness of HAIs containment practices in long-term care facilities (LTCF). This cross-sectional study included eight LTCF inspected by Prevention Technicians of the Local Health Authority Tuscany South-East (LHA-TSE) in 2023. The study evaluated non-compliance in procedures for legionellosis prevention, cleaning and disinfection, laundry management, management of pans, HAIs prevention, healthcare tools disinfection, and hairdressing services. Data were analysed using descriptive statistics and the Mann Whitney test to compare infection rates with procedure compliance. In 2023, 606 infections were reported in the eight enrolled LTCF. The most frequent infections were COVID-19 (19.4%), urinary tract infections (16.9%), pharyngitis (15.6%), and influenza-like illness (ILI) (15%). For the "Laundry Procedure," 3 LTCF were compliant and 5 were not, showing a significant relationship with influenza syndromes (p = 0.02) and surgical site infections (p = 0.04). For the "Cleaning Check" procedure, non-compliance was linked to higher fungal infections (p = 0.01) and gastroenteritis (p = 0.04). The "Disinfection of Health Tools procedure showed non-compliance correlated with higher gastroenteritis (p = 0.04) and conjunctivitis (p = 0.01). Gastrointestinal infections from Clostridium difficile were linked to non-compliance with "HAIs Procedures Routes" (p = 0.04), "Pans" processes (p = 0.04), and cleanliness in the hairdressing service (p = 0.04). Herpes simplex or Herpes zoster infections were higher in LTCF with non-compliant hairdressing service rooms (p = 0.02). Two legionellosis cases were recorded in LTCF with reported non-compliance in analytical procedures for Legionellosis. Our analysis showed significant correlations between cleanliness procedures and reductions in fungal infections, gastroenteritis, and ear infections. Compliance in laundry procedures was linked to ILI and surgical site infections. Non-compliance in healthcare tools correlated with higher rates of gastroenteritis and conjunctivitis, highlighting the need for stronger practices. The data suggest that effective prevention measures reduce HAIs, though discrepancies in implementation across facilities call for standardization and continuous monitoring.

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