Monitoring the quality of health services in ICU: ten years of the SPIN-UTI network HAI surveillance Antonella Agodi A Agodi 1 , F Auxilia 2 , M Barchitta 1 , S Brusaferro 3 , MM D’Errico 4 , MT Montagna 5 , C Pasquarella 6 , S Tardivo 7 , I Mura 8 1 University of Catania, Catania, Italy 2 University of Catania, Milan, Italy 3 University of Udine, Udine, Italy 4 University Politecnica delle Marche, Ancona, Italy 5 University of Bari, Bari, Italy 6 University of Parma, Parma, Italy 7 University of Verona, Verona, Italy 8 University of Sassari, Sassari, Italy Contact: agodia@unict.it 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) net- work’’ (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 < 0.001). After Cox regression analysis, SAPS II score above the median value, older age and emergency admission, were significantly associated to the risk of death. The presence of HAI was not significantly associated to the risk of death, although a significant contribution of antimicrobial resistance was shown. Conclusions Surveillance of HAIs is essential to improve the quality of health services especially in ICUs. The study confirmed that HAIs are associated with higher mortality and a longer length of ICU- stay especially those due to antimicrobial resistant microorgan- isms, highlighting the need for effective preventive efforts to reduce the impact of HAIs and improve the quality of care. Key messages:  Healthcare-associated infections are associated with higher mortality and a longer length of ICU-stay.  Surveillance of healthcare-associated infections is essential to improve the quality of health services especially in ICUs. Is bigger better? Findings from a review on health outcomes and processes after merging of hospitals Gianfranco Damiani G Damiani 1 , M Mariani 1 , A Acampora 1 , R Mete 2 , P Villari 3 , W Ricciardi 1 1 Institute of Public Health - Section of Hygiene, Universita ` Cattolica del Sacro Cuore, Rome, Italy 2 Local health authority Roma 2, Rome, Italy 3 Department of Public Health and Infectious Diseases, Sapienza Universita ` di Roma, Rome, Italy Contact: gianfranco.damiani@unicatt.it Background Many hospital mergers have taken place in different health systems of different countries in the last two decades. Despite governments and private healthcare sector continue pursuing these activities, little attention is paid to the assessment of their impact. The aim of this study is to comprehensively review literature on findings of hospital mergers in terms of clinical outcomes and processes. Methods A comprehensive review of the literature was carried out by querying general and scientific electronic databases. A search string was constructed using keywords. Articles, written in English, that evaluated outcomes and processes after hospital mergers were included. Results From a total of 113, 7 studies met the inclusion criteria and were included in the review. After hospital merging, 66.7% of cardiovascular mortality indicators didn’t demonstrate any significant reduction. A significant increase of readmission rate after major cardiovascular event was shown in all of the indicators. Of the obstetrics care indicators, 83.3% revealed a significant worsening. Staff perception was evaluated in 4 articles. All of them highlighted loss of management control. Most of these studies (50-75%) refer that career prospects and job dissatisfaction are feared by personnel; on the other hand, positive perception seems to be reported in good practice sharing. Conclusions Hospital mergers could determine consequences that need to be taken into account when these processes are planned. This review suggests that merger by itself doesn’t lead to expected benefits in terms of outcomes and processes. More than structural change, functional integration in health care services should be emphasized. Furthermore, these activities should be accompanied by a coherent and consistent assessment. Key messages:  Evidence do not show any automatic improvement for outcomes and processes after hospital mergers.  A systematic and periodic assessment is needed in case of merging. Inter-hospitals care pathway for Centers of Welcoming and Services for oncologic patients in Italy Giacomo Scaioli G Scaioli, F Bert, MR Gualano, E Camussi, R Siliquini Department of Public Health Sciences, University of Turin, Turin, Italy Contact: giacomo.scaioli@unito.it Issue/problem Oncologic networks with shared care pathways have been demonstrated to decrease costs and increase quality care for oncologic patients. The Oncologic Network of Piedmont (a region in the north of Italy) in 2015 promoted the production of an inter-hospital care pathway for the ‘‘Centers for Welcoming and Services’’ (CAS). These centers are the reference structure for the patients in term of welcoming, assistance, orientation and administrative support in the diagnosis of cancer. Description of the problem The area in which the care pathway has been implemented has a population of around 600.000 people and includes two local health authorities, one ‘‘hub’’ hospital and seven ‘‘spoke hospitals’’. A working group composed by medical doctors, nurses, representatives of the quality departments of each hospital, and researchers from the University of Turin was in charge to write the care pathway. The deadline for the final approval of the document was 31 December 2016. Results (effect/changes) Periodic meetings of the members of the working group were carried out in order to write the final document. This document included the statement that a patient can be sent to the CAS by the GP or by a medical specialist who suspects a cancer. It also defined the ways of communication and exchange of clinical information between CAS in the different hospitals, and the modalities of patients’ referral to the 10th European Public Health Conference: Parallel sessions 59 Downloaded from https://academic.oup.com/eurpub/article-abstract/27/suppl_3/ckx187.153/4556122 by guest on 07 July 2020