Phd in ADVANCES IN INFECTIOUS DISEASES, MICROBIOLOGY, LEGAL
MEDICINE AND PUBLIC HEALTH SCIENCES

Thesis title: An integrated approach to prevent and control healthcare-associated infections in the intensive care units of Umberto I teaching hospital of Rome: active patient surveillance, epidemiological and genotypic analysis of bacterial isolates and analysis of compliance to hand hygiene precaution among healthcare workers

Healthcare-associated infections (HAIs) pose a significant risk in intensive care units (ICUs), making surveillance and control essential for preventing hospital-acquired infections. In this study, conducted in the ICUs of Umberto I hospital, a multidisciplinary approach was adopted to prevent and manage HAIs during the SARS-CoV-2 pandemic. This approach integrated the analysis of risk factors, molecular characterization of pathogens to identify epidemic clusters, and evaluation of healthcare workers’ compliance with hand hygiene (HH). Findings indicate that the pandemic initially had a negative impact on HAI incidence in ICUs, followed by improvements in clinical outcomes. These improvements were attributed to more effective management of critically ill COVID-19 patients, growing population immunity, and a decrease in SARS-CoV-2 virulence. Despite progress, a rise in HAI incidence was also observed in neonatal ICUs, underscoring the need for continuous optimization in the care of vulnerable patients. Molecular analysis of Acinetobacter baumannii isolates further revealed an alarming spread of multidrug-resistant strains, necessitating enhanced infection control measures and the development of long-term strategies. HH compliance rates remain suboptimal, with lower adherence before patient contact and significant variability across wards, highlighting the challenges in achieving uniform compliance. In conclusion, an integrated approach combining active surveillance, molecular typing, and monitoring of healthcare worker behaviour proves valuable in controlling and preventing HAIs. To maximize its impact, it is essential to address logistical challenges, encourage staff participation, and promote continuous training to improve adherence to preventive practices, thereby enhancing patient outcomes and overall quality of care.