Testing of a model for the integration between clinical risk and infectious risk aimed at management of adverse events classifiable as hai in a second-level hospital

Hospital Acquired Infection (HAI) have a significant clinical and economic impact resulting in an extension of the length of stay, long- term disability, increased resistance of microorganisms to antibiotics, an additional economic burden on health systems and patients and their families and significant excess mortality. In high-income countries, HAI prevalence is estimated at between 3.8% and 12%. In Europe, HAI causes 16 million additional stay days each year, 37,000 attributable deaths and 110,000 deaths for which infection is a factor, 6.5% of patients in acute care settings and 3.9% of resident’s long-term care facilities had at least one HAI. The costs are estimated at approximately € 7 billion, considering the direct costs alone (1,2). A study by the European Centre for Disease Prevention and Control (ECDC) estimated that about 672,000 cases of infection with antibiotic- borne bacteria occurred in 2015 resistant, of which 63.5% were related to health care (3). Antibiotic resistance is today the most epidemiological and economic problem in our country, for which prevention and control actions are urgent (4). Despite the possibility to access new information systems and the large amount of data offered by the automatic warning systems - "big data", the management of information flows related to nosocomial infections is still very compartmentalized. Many information sources make optimizing data management enormously difficult. In particular, the challenge of integrating data on the clinical (review of medical records, SDO, incident reporting systems) and health support side (microbiology, laboratory analysis) is evident with data on the administrative side (complaints, claims). The aggregation of information flows requires a model that involves the construction of a common taxonomic platform where can be placed both data of epidemiological and clinical interest and data of close legal medical interest. In the literature, there are some international and national experiences of using reference taxonomies for the classification of events and dangers related to patient safety. The International Classification of Patient Safety (ICPS) developed by the World Health Organization (WHO) appears to be a further important step towards a comprehensive conceptual framework of patient safety, which can facilitate the comparison of results from different sources of information, both within health organizations and between institutions, at local, national and international level. As a general approach adopted by the ICPS classification, an event is defined by the process in which it occurred and by the specific problem that occurred. To this end, the identification of a model for correlating clinical risk with infectious risk, through the implementation of a common taxonomy, could facilitate the analysis of large amounts of data, the evaluation of the effectiveness of the implemented infection prevention and control interventions as well as the optimization of the resources used to reduce the infectious risk.