Safe Patient Project

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Inherent risk factors

  •     age (infants, elderly)
  •     gender (men)
  •     other infections or serious concomitant diseases (tumors, immunodeficiency, diabetes, disability, obesity, respiratory or gastric problems, temperature higher than 38 ° C at admission)
  •     trauma, burns
  •     alterations in the state of consciousness.

Risk factors related to care practices / areas or microorganisms:

  •     surgical site infections (SSIs)
  •     ventilation-related pneumonia (VAP) and hospital-acquired pneumonia (HAP)
  •     urinary tract infections related to bladder catheter (CAUTI)
  •     infections related to endoscopic procedures (especially gastric endoscopy)
  •     infections related to insertion and maintenance of peripheral or central vascular catheter
  •     infections related to ICU admission
  • difficile infection related to the use of antibiotics
  •     MRSA infection (methicillin-resistant Staphylococcus aureus).

Typology of infections

In 2011, urinary tract infections had a prevalence of 1.5%, in 2016 of 1.6%. In recent years, bacteremia has exceeded those of the urinary tract, passing from 1.1% to 1.6%. The increase in systemic infections is the consequence of a gradual increase in specific risk factors, in particular the abundant use of antibiotics and vascular catheterization.

Prevention

More than half of HAIs are preventable, especially those associated with certain behaviors, through the planning of programs to prevent and control the transmission of infections. However, it is necessary to plan and implement control programs at different levels (national, regional, local), to ensure the implementation of those measures that have proved effective in minimizing the risk of infectious complications.

Although HAIs are commonly attributable to patient variables and the quality of care provided, a dedicated organizational set-up has been shown to help prevent them. To this end, the Committee for the contrast of hospital infections (CIO) was established.

Typology of infectionsUseful resources

  •     U.S Department of Health and Human Services. Health.gov. Health Care-Associated Infections
  •     “Second Italian prevalence study on healthcare-related infections and the use of antibiotics in acute care hospitals – ECDC Protocol”. Department of Public Health and Pediatric Sciences, University of Turin. 2018
  •     The article “The preventable proportion of healthcare-associated infections 2005-2016: Systematic review and meta-analysis”, published in Infect Control Hosp Epidemiol. 2018 Nov; 39 (11): 1277-1295
  •     the article “Risk factors for health care – associated infections: From better knowledge to better prevention”, published in American Journal of Infection Control, Volume 45, Issue 10, 2017, Pages e103-e107

Bacterial infections of the urinary tract

Bacterial urinary tract infections can affect the urethra, prostate, bladder, or kidneys. Symptoms may be absent or include pollakiuria, urgency, dysuria, lower abdominal pain, and flank pain. In the case of kidney infection, systemic symptoms and even sepsis may be present. Diagnosis is based on urinalysis and urine culture. Therapy is based on antibiotic treatment and removal of urinary tract obstructions and catheters.

(See also Introduction to Urinary Tract Infections; Gram-Negative Bacilli; Prostatitis; and Urinary Tract Infections in Children.)

Among adults between the ages of 20 and 50, urinary tract infections are about 50 times more common in women. In women in this age group, most UTIs are cystitis or pyelonephritis. In men of the same age, most urinary tract infections are urethritis or prostatitis. The incidence of urinary tract infections increases in patients> 50 years, but at the same time the ratio of women: men decreases due to the increased frequency of prostatic hypertrophy and equipment in men.

Pathophysiology

The urinary tract, from the kidneys to the urethral meatus, is normally sterile and resistant to bacterial colonization, despite frequent contamination of the distal urethra by intestinal tract bacteria. The main defense against urinary infections is the complete emptying of the bladder during urination. Other mechanisms that ensure sterility include the acidity of the urine, the vesicoureteral valve, and various immunological and mucosal barriers.

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