Surveillance of bloodstream infections in intensive care units in England, May 2016–April 2017: epidemiology and ecology

Infection in Critical Care Quality Improvement Oversight Group

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)

Abstract

Background: Bloodstream infections (BSIs) in patients in intensive care units (ICUs) are associated with increased morbidity, mortality and economic costs. Many BSIs are associated with central venous catheters (CVCs). The Infection in Critical Care Quality Improvement Programme (ICCQIP) was established to initiate surveillance of BSIs in English ICUs. Methods: A web-based data capture system was launched on 1st May 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 1st May 2016 and 30th April 2017, 84 ICUs (72 adult ICUs, seven paediatric ICUs and five neonatal ICUs) based in 57 of 147 NHS trusts provided data. In total, 1474 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 per 1000 bed-days and 2.3, 1.0 and 1.5 per 1000 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 per 1000 bed-days and 0–18.3 per 1000 ICU-CVC-days). Conclusions: While the overall rates of ICU-associated CVC-BSIs were lower than 2.5 per 1000 ICU-CVC-days across all age ranges, large differences were observed between ICUs, highlighting the importance of a national standardized 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.

Original languageEnglish
Pages (from-to)1-9
Number of pages9
JournalJournal of Hospital Infection
Volume106
Issue number1
DOIs
Publication statusPublished - Sep 2020

Bibliographical note

Funding Information:
APRW has received research funding from Shionogi, acted on the Drug Safety Monitoring Board for Roche, and been on an advisory panel for Ideal Standard. The other authors report no conflicts of interest.APRW was supported, in part, by the National Institute for Health Research University College London Hospitals Biomedical Research Centre. However, this research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Funding Information:
APRW has received research funding from Shionogi , acted on the Drug Safety Monitoring Board for Roche, and been on an advisory panel for Ideal Standard. The other authors report no conflicts of interest.

Funding Information:
In England in 2008, the National Health Service (NHS) Next Stage Review announced that the National Patient Safety Agency would run an initiative to prevent CVC-BSIs using the Keystone-Michigan project as a model. The Matching Michigan project [ 8 ] was funded by the UK Department of Health and undertaken in 196 adult and 19 paediatric ICUs across England. This 2-year four-cluster stepped-wedge interventional non-randomized study encompassed both evidence-based technical interventions and non-technical interventions to encourage positive behavioural and systems change. It reported reductions in the mean rate of CVC-BSIs for both adult (3.7–1.48 per 1000 CVC-days) and paediatric (5.65–2.89 per 1000 CVC-days) ICUs. However, among the adult ICUs, each cluster that joined the study had a similar pre-entry CVC-BSI rate to postinterventional rates of clusters already in the study. Moreover, CVC-BSIs not characterized as ICU-associated (i.e. among patients hospitalized in the ICU for <2 nights, and therefore assumed to have been acquired before ICU admission) declined at a similar rate as ICU-associated BSIs, indicating a systems-wide cause for improvement.

Funding Information:
APRW was supported, in part, by the National Institute for Health Research University College London Hospitals Biomedical Research Centre . However, this research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Publisher Copyright:
© 2020

Keywords

  • Bacteraemia
  • Bacterial antibiotic resistance
  • Central venous catheters
  • England
  • Intensive care

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