Between 400 and 640 thousand infections contracted every year during hospitalization, and around 20 thousand deaths that can be attributed to them. These are the estimates of the Istituto Superiore di Sanità on healthcare-related infections, the phenomenon which in technical jargon is called ICA and which in common language remains hospital infection. The most important fact, however, concerns the fact that more than half of those cases could have been avoided. To give shape to this number, the ICA Italia Observatory was created, presented on the occasion of the National Day for the Safety of Care and the Person Assisted, which falls every 17 September. The portal brings together public data, European documents, regional surveillance and sentences, with a declared objective that distances itself from the logic of the scandal, that is, not to punish, but to understand where the system breaks down.
What the portal collects
The archive currently includes 348 sentences pronounced between 2016 and 2026 in all twenty Italian regions. The measures are published anonymously: patients, healthcare personnel and facilities are not identified, even when the names appear in the original judicial documents. From the promoters of the initiative comes a sentence that is valid as a manifesto: “Our adversary is the infection, not those who work in the wards. This is why we do not publish the name of any hospital, not even when it is written in the documents. An observatory that fuels litigation would do damage to hospitals without eliminating a single infection”. Alongside the judicial archive, a section of the site highlights the structures that have managed to measurably reduce their infections, but only those that give written consent to appear. The most recurrent cracks emerge from the sentences: catheters left in too long, contaminated operating fields, surveillance that is completely lacking, hospitals unable to document the measures they say they have adopted. With a warning that the editors of the site themselves are keen to reiterate: judicial proceedings only represent a portion of the problem, because many cases with damages end with confidential agreements or never reach a courtroom.
Because prevention is more complicated than it seems
Healthcare-related infections almost never arise from a single error, and in most cases are the result of multiple factors that add up: the fragility of the patient, the need for invasive procedures such as catheters or surgical interventions, the presence of microorganisms in the care environment, the organization (or disorganization) of work in the ward. Hand hygiene, correct management of devices, sterility of procedures, cleanliness of environments, appropriate use of antimicrobials are the measures that, according to scientific literature, really reduce the risk. But they only work if they become stable practice in a department, not if they depend on the good will of the individual nurse or doctor on duty. Clear protocols, continuous training, availability of materials, communication between departments and periodic verification of how much the procedures are actually respected are needed. This is where epidemiological surveillance comes into play, which allows us to notice when the numbers in a department deviate from the norm, to compare different periods, to identify the most exposed care steps. A reduction in infections measured over time says much more than a declaration of conformity, as long as the data is collected using homogeneous criteria and takes into account the differences between patients and departments.
The value, and limits, of documentation
Writing down what has been done (such as which catheter was used, when it was replaced and with what precautions) is certainly not a mere bureaucratic exercise, because it is what allows, in the event of a complication, to reconstruct the treatment path and quickly correct what did not work. The sentences collected by the Observatory confirm this indirectly, and a good part of the disputes arise precisely where the documentation is missing or incomplete. It must be said with equal clarity that those same sentences are not a representative sample of the phenomenon as a whole, given that they only describe the cases that came to court, not the real frequency of infections nor the average quality of Italian healthcare facilities.
From the fault of the individual to the safety of the system
Focusing attention on who made a mistake in a single case risks overlooking the organizational factors that almost always matter most, including workloads, staff turnover, continuity of care and quality of internal controls. It does not mean that professional responsibilities do not exist, it means placing them within a broader framework, that of clinical risk management. Transparency, in this sense, helps when it serves to circulate what works and what doesn’t work, not when it turns into rankings built on data that are not comparable to each other. The objective, for those who actually work in the field, must be to transform both reports and documented critical issues into verifiable interventions, capable of bringing down the number of infections without fueling a hunt for the culprit which, in the end, cures no one.
