By accounting on data coming from the Government institutions for public health, a time series forecast evaluation of deaths in Italy caused only by HAIs, should give, in non emergency period, a number of about 2,356 deaths any year, leading to an estimation for 2020 of about 58,725 deceases, very close to the 74,159 deaths reported by the Italian Ministry of Health on December 31st 2020. It is conceivable that in emergency times, where hospitals are much more crowded of sick patients and healthcare workers, this evaluation may result greatly exacerbated. Zotti et al., evaluated an averaged prevalence of HAI of about 7.84% but estimating a wider range of 0-47.8% of HAI incidence, depending on the different healthcare units and hospital involved in the survey . The Italian Institute of Statistics reported that deaths in Italy amounted to 630000 (page 4 of 10 to the link https://www.istat.it/it/files/2019/07/Statistica-report-Bilancio-demografico-2018.pdf) in 2018, so a number of about 49,000 deaths caused by HAI represents a 7.74%, very close to the HAI values reported so far. So, how many patients really die in ICUs during the current COVID-19 pandemic because of HAIs?
This amount is particularly hard to be correctly estimated, particularly because of frailty due to elderly people with co-morbidities and for season effects . The SPIN-UTI survey reported a mortality rate due to HAI not so far from 17–18%, i.e. on a mean of 2564 patients in 35 ICUs in the year range 2006–2011, averaged deaths in ICUs due to HAIs amounted to 463, for an age range of 65–66 years . Moreover, Agodi et al., reported that the Relative Risk to die in an ICU due to HAIs increased throughout the years, i.e. RR = 2.25 (CI95 = 1.90–2.66) in 2006–2007, RR = 2.96 (CI95 = 2.48–3.54 in 2008–2009 and RR = 3.19 (CI95 = 2.71–3.74 in 2020-201113. During the first months of the COVID-19 outbreak in Italy, the overall case-fatality was higher (7.2%) than in China (2.3%), despite the fact that when data were stratified for age groups, the re-calculated case-fatality rate was perfectly comparable between Italy and China for ages 0–69, yet rates were higher for Italy in ages ≥ 70 years old, particularly for ages higher than 80. The authors were unable to explain this difference .
A recalculation made in our labs of the RR value to die in hospitals during COVID-19 pandemic because of nosocomial infections in 2020, taking into account the number of deaths provided by the Italian Ministry of Health on December 31st 2020 and values about HAIs in current literature, leads to RR = 8.47 (CI95 = 8.38–8.56, odds ratio (OR) = 8.55). A correct strategy in public health management should take into account, therefore, regarding the real impact of HAIs in ICUs and health care units during this dramatic COVID-19 emergency. Yet, this concern may have been particularly underestimated during the most acute increase in SARS-CoV2 infections, if politics attempted solutions for patients’ hospitalization in ICUs taking into account hotels and further temporary structures such as camp tents, though equipped, but notoriously devoid of stringent measures of HAI dampening respect to an hospital care unit. Furthermore, public mainstream opinion, via either press release or social networks, never moved an outcry or expanded a debate of impact about this concern, probably because any consideration was abruptedly overwhelmed by the dramatic tale about COVID-19 infections and associated deaths we were compelled to hear day by day. Science should wonder if exacerbation following SARS-CoV2 infection was mostly due to super-infections with environmental bacteria, a circumstance that, if it could be true that deaths are closely associated to COVID-19 diagnosis, such deaths might be greatly prevented by reducing HAIs incidence. The close superimposition one can evaluate between estimated HAI-caused deaths and COVID-19 deceases, should suggest for the existence of statistical confounders in the description of COVID-19 pandemic in Italy.