Healthcare-associated Bloodstream Research Articles

Healthcare-associated infection in the Grey’s Hospital paediatric intensive care unit: does an Infection Control Programme work?

Background: Healthcare-associated infections are an important cause of morbidity and mortality globally. Grey’s Hospital introduced an Infection Control Programme in August 2016, which included Best Care Always bundles for reducing the occurrence of central line-associated bloodstream infections, catheter-associated urinary tract infections and ventilatorassociated pneumonia. Methods: An observational before–after quasi-experiment was conducted retrospectively reviewing healthcare-associated infection rates in the Grey’s Hospital paediatric intensive care unit a year prior to (August 2015 to July 2016) and after (September 2016 to August 2017) implementation of an Infection Control Programme.Results: There was an absolute decrease in healthcare-associated infection from 102 to 81 and a statistically significant decrease in bloodstream infections per 1 000 central venous catheter days from 36/1 000–15/1 000 after intervention (RR 0.42, 95% CI 0.23–0.79, p = 0.004). The rate of healthcare-associated infection decreased from 23/100 admissions prior to the intervention to 20/100 admissions after the intervention (RR 0.87, 95% CI 0.51–1.48, p = 0.61) and from 40/1 000 patient days to 32/1 000 patient days (RR 0.80, 95% CI 0.51–1.26, p = 0.34). Reductions in healthcare-associated infection were also seen in bloodstream infections and urinary tract infections.Conclusion: The observed downward trend in overall healthcare-associated infections, bloodstream infections and urinary tract infections did not reach statistical significance except for bloodstream infections per 1 000 central venous catheter days. Further research or audit is needed to ascertain reasons for this less than expected decrease in healthcare-associated infections. In the meantime, meticulous adherence to bundles should be encouraged.

A comparison of blood stream infections with extended spectrum beta-lactamase-producing and non-producing Klebsiella pneumoniae in pediatric patients

BackgroundRapid development and global spread of multidrug resistant Klebsiella pneumonia (K. pneumoniae) as a major cause of nosocomial infections is really remarkable. The aim of this study was to explore risk factors for health care associated blood stream infections (BSI) caused by ESBL-producing K. pneumoniae in children and analyze clinical outcomes.MethodsA retrospective review of patients younger than 18 years-old with blood stream infection caused by K. pneumoniae was performed. Patients with ESBL-producing K. pneumoniae isolates were compared with ESBL-non-producing isolates in terms of risk factors, outcome and mortality.ResultsAmong 111 K. pneumoniae isolates 62% (n = 69) were ESBL –producing K. pneumoniae. The median total length of hospitalization and median length of stay in hospital before infection was significantly higher in patients with ESBL-producing isolates than ESBL-non-producing. Use of combined antimicrobial treatment was significantly different between ESBL-producing and ESBL-non-producing groups, 75.4% and 24.6%, respectively (p = 0.001). Previous aminoglycoside use was higher in cases with ESBL –producing isolates (p = 0.001). Logistic regression analysis showed a significant correlation between mortality and use of combined antibiotics (OR 4.22; p = 0.01).ConclusionESBL production in K. pneumoniae isolates has a significant impact on clinical course of BSIs. Total length of hospitalization, length of hospital stay before infection, prior combined antibiotic use and use of aminoglycosides were significant risk factors for development of ESBL-producing K. pneumoniae related BSI.

Analysis of Characteristics and Prognosis of Healthcare-Associated Secondary Bloodstream Infection

Analysis of Characteristics and Prognosis of Healthcare-Associated Secondary Bloodstream Infection

Incidence and determinants of health care associated blood stream infections at a neonatal intensive care unit in Ujjain, India: Results of a prospective cohort study

this overall underprivileged population, factors found to be associated with colonization were mostly indicative of a somewhat higher socioeconomic status, potentially linked to a better access to healthcare services (and opportunities for ESBL-PE transmission or antibiotics prescription). While not found to be a significant factor in multivariate analysis, antibiotics use deserves to be further explored. Funding: Principality of Monaco

348Rising incidence of carbapenem resistance in health care associated blood stream infections in a tertiary care hospital in Mumbai, India

348Rising incidence of carbapenem resistance in health care associated blood stream infections in a tertiary care hospital in Mumbai, India

Healthcare-associated (HA) bloodstream infections (BSI) secondary top surgical site infections: surveillance program across Quebec hospitals (2007 to 2010)

Results 56 of the 89 eligible centers participated (67% of shortterm hospital beds), 64 % of those beds were in teaching hospitals. Of the 7709 episodes of HA-BSIs, 874 (11 %) were secondary to a SSI. Gastrointestinal surgeries were, by far, the leading cause of BSIs (244 – 28%) followed by cardiac surgery (132 – 15%), and orthopaedic surgery (98 – 11%). Implants were present in 25 cases (19%). The majority of SSIs (496 -57%) were organ space infections. S. aureus was the organism most often isolated in 28% (274), followed by E. coli in 13% (130) of patients. Overall, 79% of patients were admitted on a general/specialised ward upon onset, compared to 15% in ICU, and 6% in ambulatory care. The mean time to infection was 21 days with a median of 10 days (median time to infection for cardiac compared to gastrointestinal surgery: 11 and 8 days respectively). 75% of BSIs occurred in teaching hospitals.

Healthcare associated bloodstream infections – secular trends of 8 years hospital-wide surveillance in a tertiary care university hospital

Healthcare-associated bloodstream infection (BSI) is the 4th major infection complication in medical care. BSI-surveillance is thought to be useful in monitoring trends of healthcare-associated infections (HAI) including outbreaks, emerging multiresistant pathogens, and effects of HAI intervention programmes.

Uniform national denominator definitions for infection control clinical indicators: surgical site and health care associated blood stream infection

The National Advisory Board (NAB) to the Australian Infection Control Association (AICA) is a multi-disciplinary group representing all regions of Australia. The group comprises infection control practitioners (ICPs), infectious disease physicians, microbiologists, epidemiologists and representatives of other stakeholder groups.Currently, there is wide variation in surveillance practices in Australia. In response, the NAB has developed standard definitions and terminology for surveillance of surgical site (SSI) and health care associated blood stream infection (BSI). Following review of overseas surveillance systems, achievement of consensus among NAB members regarding indicator terminology and methodology, and consultation with end users and stakeholder groups, consensus numerator definitions have been published. In similar fashion, denominator definitions have now been developed and are presented in this article, together with suggestions for evaluating infection outcomes (signal infections) in facilities where rate calculations are not appropriate. These definitions provide Australian ICPs in all health care facilities with a standardised strategy for surveillance. National standardisation of data collection methodology is essential if Australia is to identify acceptable national thresholds for infection rates.