Monitoring the quality of health services in ICU: ten years of the SPIN-UTI network HAI surveillance

Background: Healthcare-associated infections (HAIs) represent a significant burden among infectious diseases in Europe. The main aim of the present study, in the framework of the "Italian Nosocomial Infections Surveillance in Intensive Care Units (ICUs) network” (SPIN-UTI), was to investigate the impact of HAI on mortality and length of ICU stay Methods: Patient-based surveillance was conducted from the 79 participating ICUs during the period 2006-2015 using the European protocol for surveillance of HAIs in ICU (ECDC HAI-Net ICU protocol). A 30-day survival analysis was performed using the Kaplan-Meier function and comparisons among survival rates by the log-rank test. The risk of death was estimated using Cox regression analysis. Results: A total of 13103 patients were enrolled and the risk of HAI was 13.5 per 100 patients. Considering all patients, the risk of death did not change significantly. However, the risk of death was 2.5 significantly higher for infected patients compared with patients without infection. 30-day survival was significantly lower in infected patients (Log Rank - Mantel-Cox test, p<0,001). Patients who developed HAI during their hospitalization in the ICU, stayed in the unit over twice as long as patients without infections (17.9 vs. 8.0 days; p