Surveillance of catheter-related infections: the supplementary role of the microbiology laboratory.

Wilhelmina Strasheim,Andries W Dreyer,Veronica Ueckermann,Marthie M Ehlers,Ebrahim Hoosien,Martha M Kock

doi:10.1186/s12879-014-0743-5

Wilhelmina Strasheim, Andries W Dreyer + Show 4 more

Open Access

https://doi.org/10.1186/s12879-014-0743-5

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Abstract

BackgroundThe burden of catheter-related infections (CRIs) in developing countries is severe. In South Africa, a standardised surveillance definition does not exist and the collection of catheter days is challenging. The aim of the study was to provide baseline data on the prevalence of CRIs and to describe the epidemiology of CRI events within a tertiary academic hospital.MethodsSurveillance was laboratory-based and conducted for a six month period. A microbiologically confirmed CRBSI (MC-CRBSI) event was defined as the isolation of the same microorganism from the catheter and concomitant blood cultures (BCs), within 48 h of catheter removal, which were not related to an infection at another site.ResultsA total of 508 catheters, removed from 332 patients, were processed by the laboratory, of which only 50% (253/508 removed from 143/332 patients) of the catheters were accompanied by BCs within 48 h. Sixty-five episodes of MC-CRBSI in 57 patients were detected, involving 71 catheters and 195 microbial isolates. The institutional prevalence rate was 3.7 episodes per 1 000 admissions and 5.8 episodes per 10 000 in-patient days. Catheter day data was collected in only six wards of the hospital. The pooled laboratory incidence was 10.1 MC-CRBSI episodes per 1 000 catheter days, whereas the hospital-based central line-associated bloodstream infection (CLABSI) rate was pooled at 5.7 episodes per 1 000 catheter days. The majority of patients had an underlying gastro-intestinal condition (33%; 19/56) with a non-tunnelled, triple-lumen central venous catheter, placed in the subclavian vein (38%; 27/71). The most predominant pathogen was methicillin-resistant Staphylococcus epidermidis (28%; 55/195), followed by extensively-drug resistant Acinetobacter baumannii (18%; 35/195).ConclusionsCatheter-related infection prevention and control efforts require urgent attention, not only to keep patients safe from preventable harm, but to prevent the spread of multidrug resistant microorganisms.

Highlights

The burden of catheter-related infections (CRIs) in developing countries is severe
Are CRIs associated with increased mortality, these infections contribute an increased length of hospital stay and increased healthcare costs, which is problematic in a limited-resource setting, such as South Africa [3,4]
Episodes of MC-CRBSI A total of 508 catheter tips removed from 332 patients were processed by the microbiology laboratory during the six month study period

Summary

Introduction

In South Africa, a standardised surveillance definition does not exist and the collection of catheter days is challenging. Catheter-related infections [CRI(s)] in sub-Saharan Africa pose a significant threat to a hospitalized patient’s safety [1,2]. Are CRIs associated with increased mortality, these infections contribute an increased length of hospital stay and increased healthcare costs, which is problematic in a limited-resource setting, such as South Africa [3,4]. A focus on education and strict adherence to infection prevention and control programmes are associated with a reduction in CRI rates [5]. The first step in reducing CRIs, prior to the implementation of education and prevention programmes, is to define the extent of the problem through surveillance [4,6]. There is lack of uniformity of the case definition of a CRI among different organisations in various geographical locations [8,9,10,11]

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