Abstract:
Background/Aim: Bloodstream infections (BSI) in Intensive Care Unit (ICU) patients are associated with increased morbidity, mortality and economic costs. Many BSI are associated with central venous catheters (CVCs). We established the Infection in Critical Care Quality Improvement Programme (ICCQIP) to initiate surveillance of BSIs in English ICUs.
Methods: A web-based data capture system was launched 01/05/2016 to collect all positive blood cultures (PBCs), patient-days and CVC-days. National Health Service (NHS) Trusts in England were invited to participate in the surveillance programme. Data were linked to the antimicrobial resistance dataset maintained by Public Health England and to mortality data.
Findings: Between 01/05/2016 and 30/04/2017, 84 ICUs (72 adult, seven paediatric, five neonatal) based in 57/147 NHS Trusts provided data. A total of 1,474 PBCs were reported, with coagulase-negative staphylococci, Escherichia coli, Staphylococcus aureus and Enterococcus faecium being the most commonly reported organisms. The rates of BSI and ICU-associated CVC-BSI were 5.7, 1.5 and 1.3/1,000 bed-days and 2.3, 1.0 and 1.5/1,000 ICU-CVC-days in adult, paediatric and neonatal ICUs, respectively. There was wide variation in BSI and CVC-BSI rates within ICU types, particularly in adult ICUs (0-44.0/1,000 bed-days and 0-18.3/1,000 ICU-CVC-days).
Conclusions: While the overall rates of ICU-associated CVC-BSIs were lower than 2.5/1,000 ICU-CVC-days across all age-ranges, large differences were observed between units, highlighting the importance of a national standardised surveillance system to identify opportunities for improvement. Data linkage provided clinically important information on resistance patterns and patient outcomes at no extra cost to participating Trusts.
Reference:
Gerver, S.M., Mihalkova, M., Bion, J.F., Johnson, A.P. and Hope, R. (2020) Surveillance of Bloodstream Infections in Intensive Care Units in England, May 2016-April 2017: Epidemiology and Ecology. The Journal of Hospital Infection. May 15th. DOI:https://doi.org/10.1016/j.jhin.2020.05.010. (epub ahead of print).