Variations in catheter-related bloodstream infections rates based on local practices

Soraya Cherifi,Marie Hallin,Georges Mascart,Marie-Laurence Lambert,Anne Dediste,Baudouin Byl,Michèle Gerard

doi:10.1186/2047-2994-2-10

Abstract

BackgroundCatheter-related bloodstream infection (CRBSI) surveillance serves as a quality improvement measure that is often used to assess performance. We reviewed the total number of microbiological samples collected in three Belgian intensive care units (ICU) in 2009–2010, and we described variations in CRBSI rates based on two factors: microbiological documentation rate and CRBSI definition which includes clinical criterion for coagulase-negative Staphylococcus (CNS) episode.FindingsCRBSI rates were 2.95, 1.13 and 1.26 per 1,000 estimated catheter-days in ICUs A, B and C, respectively. ICU B cultured fewer microbiological samples and reported the lowest CRBSI rate. ICU C had the highest documentation rate but was assisted by support available from the laboratory for processing single CNS positive blood cultures. With the exclusion of clinical criterion, CRBSI rates would be reduced by 19%, 45% and 0% in ICUs A, B and C, respectively.ConclusionCRBSI rates may be biased by differences of blood culture sampling and CRBSI definition. These observations suggest that comparisons of CRBSI rates in different ICUs remain difficult to interpret without knowledge of local practices.

Highlights

Nosocomial bloodstream infections (BSIs) are an important problem worldwide
Catheter-related bloodstream infection (CRBSI) rates may be biased by differences of blood culture sampling and CRBSI definition
These observations suggest that comparisons of CRBSI rates in different intensive care units (ICU) remain difficult to interpret without knowledge of local practices

Summary

Introduction

Nosocomial bloodstream infections (BSIs) are an important problem worldwide. BSIs comprised 14% of all nosocomial infections in Belgium in 2007 [1]. Catheter-related bloodstream infection (CRBSI) is a leading cause of BSI, in intensive care units (ICUs), where it is associated with significant patient morbidity and mortality and increased health care costs [2]. In 2010, the Belgian National Program for Surveillance of Hospital Infections (NSHI) reported a mean incidence of CRBSI of 1.4 (95% CI: 1.3-1.5) per 10,000 patient-days [3]. In 2011, a six-month prospective surveillance study was conducted in ICUs A and B to measure the CVC utilization ratio (defined as the ratio between catheter-days and patient-days), resulting in a ratio of 0.75. Catheter-related bloodstream infection (CRBSI) surveillance serves as a quality improvement measure that is often used to assess performance. We reviewed the total number of microbiological samples collected in three Belgian intensive care units (ICU) in 2009–2010, and we described variations in CRBSI rates based on two factors: microbiological documentation rate and CRBSI definition which includes clinical criterion for coagulase-negative Staphylococcus (CNS) episode

Results

Discussion

Conclusion