Quality Of Critical Care Research Articles

Association Between Different DVT Prevention Methods and Outcomes of Septic Shock Caused by Intestinal Perforation in China: A Cross-Sectional Study.

IntroductionSeptic shock, largely caused by intestinal perforation, is the most common critical illness in intensive care unit (ICU). As an important quality control strategy in ICU, deep vein thrombosis (DVT) prevention is routinely used in the treatment of septic shock. Nevertheless, the effects of DVT prevention on septic shock are not fully revealed. This study was thus designed to investigate the effects of DVT prevention on septic shock caused by intestinal perforation in China.MethodsA total of 463 hospitals were enrolled in a survey, led by the China National Critical Care Quality Control Center (China NCCQC) from January 1, 2018 to December 31, 2018. The association between DVT prevention, including pharmacological prophylaxis and mechanical prophylaxis, and outcomes, such as prognosis, complications, hospital stays, and hospitalization costs, was determined in the present study.Main ResultsNotably, the increased rates of DVT prevention were not associated with the onset of complications in patients with septic shock caused by intestinal perforation (p > 0.05). In addition, even though increased DVT prevention did not affect hospital stays, it significantly decreased the discharge rates without doctor's order in patients with septic shock caused by intestinal perforation (p < 0.05). Nevertheless, it should be noted that the rates of pharmacological prophylaxis but not mechanical prophylaxis were significantly associated with the costs of septic shock caused by intestinal perforation (p < 0.05). Although increased total rates of DVT prevention and the rates of mechanical prophylaxis did not reduce the mortality in patients with septic shock caused by intestinal perforation, the higher frequent intervention using pharmacological prophylaxis indicated the lower mortality of these patients (p < 0.05).ConclusionsDVT prevention by any means is a safe therapeutic strategy for treating septic shock caused by intestinal perforation, and pharmacological prophylaxis reduced the mortality of patients with septic shock caused by intestinal perforation.

Nursing management of the critical thinking and care quality of ICU nurses: A cross-sectional study.

To explore the effectiveness of a digital learning management system in enhancing intensive care unit nurses' critical care knowledge and critical thinking tendency. Learning intensive care unit knowledge and skills is essential for the continuing education of nurses, and impacts patient health outcomes. Enhancing intensive care unit nurses' critical care abilities is a medical care quality concern in clinical practice. A cross-sectional study was conducted with 212 participants to investigate the effects of a digital learning system on care quality. After the implementation of the digital learning system, intensive care unit nurses' critical care knowledge and critical thinking skills increased significantly. High-level nurses had higher critical thinking scores. All participants associated critical care knowledge with improved quality of care. The digital learning management system enhanced intensive care unit nurses' critical care knowledge. Optimizing nursing care safety and quality requires that nursing staff to be at an adequate level, which improves their critical care ability. A well-designed digital learning management system with structured classes may allow intensive care unit nurses to learn effectively and can be used for continuing education. These results are of interest to nursing management staff who want to invest in the continued professional development of intensive care unit nurses to improve critical care knowledge, critical thinking skills, care quality, and health care value.

Perception of interdisciplinary collaboration between ICU nurses and resident physicians during the COVID-19 pandemic.

Multidisciplinary collaboration is the hallmark of quality critical care. Prior studies have shown that nurses and physicians have different perceptions on communication and collaboration in the ICU. The Covid-19 pandemic has served to both strain and strengthen relationships between nurses and resident physicians in the ICU. This study used a survey-based approach sought to identify the similarities and differences between perception of collaboration between ICU nurses and resident physicians taking care of patients during the pandemic, and to identify whether they felt that the pandemic impacted the collaborative spirit of critical care. Although findings from this study suggest that overall residents and nurses perceive collaboration similarly, the COVID-19 pandemic may be differentially affecting the interdisciplinary dynamics of the ICU.

Measuring care quality in paediatric critical care

Introduction: Children admitted to paediatric critical care units are especially susceptible to hospital-acquired complications (HACs) and infections (HAIs) from the underlying illness and the potential adverse effects from related therapeutic interventions. Consequently, there is increasing international interest in measuring care quality in paediatric critical care, with such efforts essential to drive quality improvement and infection prevention programs.

Discussion Guide for the Hua Article.

Discussion Guide for the Hua Article.

A Prospective Study of Severe Acute Maternal Morbidity and Maternal Near Miss in a Tertiary Care Hospital.

The identification of severe cases of maternal morbidity has emerged as an approach to mitigating maternal deaths. The main objective of the study was to analysethe causes of (severe acute maternal morbidity) SAMM and maternal (near miss) NM among pregnant women and the associated risk factors. The study was conducted on pregnant women (n = 300) who were diagnosed as SAMM (n = 269) and NM (n = 31). Patient details including age, parity, gestational age at admission, antenatal history, morbidity conditions, mode of delivery, and ICU admission with life-saving medical and surgical interventions were recorded. Multinomial logistic regression analysis was performed to assess the risk factors associated with SAMM and NM. The most common cause of maternal death was hemorrhage. The maternal NM incidence ratio was 11.58/1000 live births, maternal NM mortality ratio was 2.5:1, and the mortality index was 3.8% with SAMM and NM and 27% with life-threatening complications.Women with low education status, multiparity, third trimester and postpartum period, suboptimal antenatal visits, and a lack of awareness were at increased risk of SAMM and NM. This study adds on to the existing knowledge of SAMM and NM highlighting the need of early diagnosis and need of overall improvement in quality critical care management for maternal health and its timely accessibilityto substantially reduce maternal deaths. Active management of third-stage of labor, early recognition and emergency management of severe hypertension widely contribute toward reducing the number of both SAMM and NM.

A scoping review of registry captured indicators for evaluating quality of critical care in ICU

BackgroundExcess morbidity and mortality following critical illness is increasingly attributed to potentially avoidable complications occurring as a result of complex ICU management (Berenholtz et al., J Crit Care 17:1-2, 2002; De Vos et al., J Crit Care 22:267-74, 2007; Zimmerman J Crit Care 1:12-5, 2002). Routine measurement of quality indicators (QIs) through an Electronic Health Record (EHR) or registries are increasingly used to benchmark care and evaluate improvement interventions. However, existing indicators of quality for intensive care are derived almost exclusively from relatively narrow subsets of ICU patients from high-income healthcare systems. The aim of this scoping review is to systematically review the literature on QIs for evaluating critical care, identify QIs, map their definitions, evidence base, and describe the variances in measurement, and both the reported advantages and challenges of implementation.MethodWe searched MEDLINE, EMBASE, CINAHL, and the Cochrane libraries from the earliest available date through to January 2019. To increase the sensitivity of the search, grey literature and reference lists were reviewed. Minimum inclusion criteria were a description of one or more QIs designed to evaluate care for patients in ICU captured through a registry platform or EHR adapted for quality of care surveillance.ResultsThe search identified 4780 citations. Review of abstracts led to retrieval of 276 full-text articles, of which 123 articles were accepted. Fifty-one unique QIs in ICU were classified using the three components of health care quality proposed by the High Quality Health Systems (HQSS) framework. Adverse events including hospital acquired infections (13.7%), hospital processes (54.9%), and outcomes (31.4%) were the most common QIs identified. Patient reported outcome QIs accounted for less than 6%. Barriers to the implementation of QIs were described in 35.7% of articles and divided into operational barriers (51%) and acceptability barriers (49%).ConclusionsDespite the complexity and risk associated with ICU care, there are only a small number of operational indicators used. Future selection of QIs would benefit from a stakeholder-driven approach, whereby the values of patients and communities and the priorities for actionable improvement as perceived by healthcare providers are prioritized and include greater focus on measuring discriminable processes of care.

Thirty-six critical cases of emergency helicopter transferring between hospitals

To summarize critical cases of emergency helicopter transferring between hospitals and improve the quality and safety of critical care. The task records of Guangxi Aviation Medical Rescue Training Base from September 2017 to September 2020 were retrieved. The mission acceptance, implementation results, disease spectrum composition, pre-transfer preparation and medical intervention on board were summarized. (1) General information: a total of 168 patients of helicopter transfer requests were registered, of which 36 patients were transferred, 35 patients were successful, 1 patient had cardiac arrest during the landing phase, and died several hours after continuous resuscitation. Of the 36 patients 30 were males and 6 were females, with median age of 50.5 (29.8, 66.0) years old, the average transfer time was (54.95±17.89) minutes, and the average transfer distance was (205.74±74.68) km. (2) Disease spectrum included 11 cases of stroke (30.55%), 7 cases of trauma (19.45%), 5 cases of severe pneumonia (13.89%), 5 cases of heart and macro-vascular diseases (13.89%), 5 cases of abdominal emergency (13.89%), and 3 other conditions (8.33%). (3) Severity: 31 patients (86.11%) were severe (≥ 15) according to acute physiology and chronic health evaluation II (APACHE II) score; 19 patients (52.78%) were high-risk emergency transport (≥ 6) according to Hamilton early warning score (HEWS); 6 patients (85.71% of trauma patients) were severe trauma (≥ 16) according to injury severity score (ISS). (4) Preparation before transfer: remote consultation was carried out to evaluate the latest state of the patient's condition, especially the respiratory and circulatory conditions. Relevant items were reviewed and emergency treatments were implemented when necessary. Targeted preparation was made for accidents that might occur during transfer, such as electrocardiogram (94.44%), blood gas analysis (94.44%), brain CT (36.11%) and other auxiliary examinations, endotracheal intubation or tracheotomy (72.22%), deep vein catheterization (91.67%), placement of gastric tube (86.11%) and urinary tube (88.89%), adjustment of sedative (38.89%), vasoactive drugs (58.33%) and drugs for dehydration and lowering intracranial pressure (33.33%), and fixation of fracture (11.11%), etc. (5) On-board medical intervention: cardiac monitoring, blood pressure, respiration and blood oxygen monitoring were carried out in all patients. The parameters of patients using ventilator were adjusted in time (66.67%). The dosage of patients using micropump was adjusted in time (91.67%). Other aspects included the use of sedative and analgesics (38.89%), sputum suction nursing (75.00%), all kinds of catheter nursing (endotracheal intubation/incision nursing of 72.22%, indwelling catheter nursing of 88.89%), and cardiopulmonary resuscitation for patient with cardiac arrest (2.78%). As the patients transferred by helicopter are mainly those of critically ill at this stage, the requirements for airborne medical equipment and rescue technology are high, and there is an urgent need to establish technical specifications and personnel training standards.

Procalcitonin in general internal medicine: a bibliometric analysis.

Procalcitonin (PCT) plays an important role in the identification of bacterial infection and therapy guidance. The relevant literature is mainly classified under critical care medicine or infectious disease. The research status of PCT in general internal medicine (GIM) is currently unclear. This research aimed to analyze PCT-related literature in the GIM field and provide references for future research. A subject search strategy was used for the term PCT, with the search scope limited to Medicine, General & Internal. We conducted a search of relevant literature in the Science Citation Index Expanded (SCIE) database in the Web of Science Core Collection (WOSCC), with no publication date limit (1900 to May 16, 2021, the date of the final search for this study). The search results were analyzed using CiteSpace software to assess the status of PCT research in the GIM field based on annual paper publication numbers, the number of citations, country distribution, institution distribution, author distribution, journal distribution, and keyword usage. A total of 905 document records were retrieved. Articles were mainly from Europe, the United States, and China, and the number of citations totaled 15,917. There were 5 research institutions that published more than 10 related papers and 3 authors who published more than 10 papers. There was little cooperation between authors from different countries and institutions. This field should focus on leading journals in critical care medicine and quality comprehensive journals. Keyword analysis showed that the current research focus is the standardized application of PCT. There are few targeted studies on the application of PCT in GIM, and the relevant important literature mainly comes from other journals. GIM-specific research should be increased in the future.

Music intervention for sleep quality in critically ill and surgical patients: a meta-analysis

ObjectiveSleep disruption occurs frequently in hospitalised patients. Given the potential of music intervention as a non-pharmacological measure to improve sleep quality, we aimed to assess and quantify current literature on...

Clinical Characteristics and Maternal Outcome of Obstetrics Patients Admitted to the Intensive Care Unit: Cross Sectional Observational Study

Background: According to UNICEF India, annually 44,000 women die due to preventable pregnancy related causes in India. Globally, this ratio is 830 maternal deaths daily according to a WHO newsletter from 2018. ICU / HDU facility provides simultaneous expert obstetrics care and critical medical care under one roof. The concept of ICU / HDU was introduced as a bridge between routine obstetric care and ICU / HDU in under to bypass and decrease the ICU / HDU burden. ICU / HDU care is required for women requiring more detailed observation, intervention including basic support for a single failing organ system, extended post-op care and those stepping down from higher levels of care. Awareness regarding ICU / HDU care and its benefits need to be improved. This study aims to study the maternal outcome of women admitted in tertiary care hospital, Karimnagar, Telangana. Methodology: This is cross sectional observational study was conducted in the department of obstetrics and gynaecology at Chalmeda Anand Rao Institute of Medical Sciences and hospital, Karimnagar, Telangana from June 2019 to March 2020 after obtaining clearance from the institutional scientific and ethical committees. In this study total 600 patients were recruited, out of these 150 patients not met the inclusion criteria &amp; 450 women recruited for questionnaire based proforma, were selected for the study calculated by SPSS 20 software. They have been subjected to thorough history taking, general, obstetric examination and assessment of antenatal records &amp; management &amp; their outcome. Results: The mean age group is 25 yrs. Also found most admission in age group between 20 to 30 yr. Most of the cases were belong to low socioeconomic status (99.2%), Occupationally maximum were unskilled worker (98.3%) in present study, Most of the cases were have secondary level of education (91.6%). In this present study 180 were hypertensive disorder of pregnancy, followed by 128 were haemorrhage disorder of pregnancy, 108 were medical disorder of pregnancy &amp; 34 were sepsis. Maternal mortality was 8.7% in this study. Conclusion: Commonest cause of mortality was hypertensive disorder of pregnancy &amp; more than one diagnosis on admission were the other risk factors for ICU / HDU admission. A dedicated ICU / HDU will go a long way in reducing maternal mortality as the responses time from onset of acute severe illness to provision of high quality critical care will be substantially reduced. Keywords: ICU / HDU, Maternal Outcome, Mortality, Critical Care Unit.

Analysis of structure indicators influencing 3-h and 6-h compliance with the surviving sepsis campaign guidelines in China: a systematic review

BackgroundCompliance with the surviving sepsis campaign (SSC) guidelines (Cssc) is a key factor affecting the effects of sepsis treatment. We designed this study to investigate the relationships of the structure indicators of ICU on 3 and 6-h Cssc in China.MethodsA total of 1854 hospitals were enrolled in a survey, led by the China National Critical Care Quality Control Center (China-NCCQC) from January 1, 2018, through December 31, 2018. We investigated the 1854 hospitals’ 3 and 6-h Cssc, including compliance with each specific measure of the 3-h and 6-h SSC bundles. We also investigated the actual level of the structure indicators of ICU, released by China-NCCQC in 2015.The outcomes were in adherence with the SSC guidelines (2016). Monitoring indicators included 3 and 6-h Cssc.ResultsIn the subgroup, the rate of broad-spectrum antibiotic therapy was the highest, and the rate of CVP and ScvO2 measurement was the lowest among the items of 3 and 6-h Cssc. Structure indicators related to 3 and 6-h Cssc include the predicted mortality rate and the standardized mortality ratio (SMR). The relationships between 3 and 6-h Cssc and the proportion of ICU in total inpatient bed occupancy, the proportion of acute physiology and chronic health evaluation (APACHE) II score ≥ 15 in all ICU patients were uncertain. There was no relationship of 3 and 6-h Cssc with the proportion of ICU patients among total inpatients.ConclusionsStructure indicators influencing 3 and 6-h Cssc in China are the predicted mortality rate and the standardized mortality rate.

Reducing the Incidence of Medical Adhesive-Related Skin Injuries in Surgical Intensive Care Unit

Patients with critical illnesses face an elevated risk of medical adhesive relation skin injuries (MARSI), which have negative, subsequent impacts on recovery and quality of healthcare. The aim of this project was to decrease the incidence of MARSI in the surgical intensive care unit and to improve the accuracy of MARSI preventive care implementation. The intervention included the implementation of product-use cards, high-risk warning slogans, education programs, experience workshops, and a standard prevention-care protocol for MARSI. After project implementation, the incidence rate of MARSI decreased from 18.2% to 0%-9.3%, and the accuracy rate of preventive care increased from 38.6% to 95.5%. This project effectively reduced the incidence of skin injury and improved the quality of critical care. The skills related to the care and prevention of MARSI have been implemented throughout the hospital.

Factors Associated with Quality of Dying and Death in Korean Intensive Care Units: Perceptions of Nurses.

The objective of this study was to investigate the factors affecting the quality of dying and death among terminally ill patients in an intensive care unit in Korea using a cross-sectional, online survey. A total of 300 nurses in the intensive care unit who had cared for a terminally ill patient for at least 48 h prior to death in the past six months were chosen to participate. The person-centered critical care nursing (PCCN) score and quality of dying and death (QODD) had a positive correlation. The QODD score increased when the consultation was conducted between the terminally ill patients and their doctors when CPR was not performed within 48 h of death, and when the PCCN score increased. The quality of death of patients is affected by whether they have sufficiently consulted with healthcare providers regarding their death and how much respect they receive. It is important for nurses to practice and improve patient-centered nursing care in order to ensure a good quality of death for terminally ill patients.

Quality Assurance in Intensive Care Medicine: Peer Reviews and Quality Indicators

Goal-oriented quality management in health care is an essential tool to provide good medical practice and treatment. It aims at a patient-centred case management with high transparency of structural and clinical process aspects, as well as patient outcome. An objective and comprehensive description of clinical care includes the use of quality indicators. However, the appliance of those indicators falls short, when the evaluation of quality is not followed by recommendations for improvement.As a highly specified area in health care provided in hospitals, intensive care medicine is characterized by complex interprofessional and multidisciplinary approaches. In addition, critical care units are an expensive resource. In order to provide an economic and yet high quality patient care, treatments should be evidence-based, and cost-drivers must be analysed for their effectiveness on patient-outcome.Various methods of quality assurance allow for a formative evaluation of intensive care units by peer reviews, including the use of quality indicators. This article focuses on peer review systems currently applied in German hospitals, and particularly describes quality indicators that have been established by DIVI (German Interdisciplinary Society of Intensive Care and Emergency Medicine). It also addresses the need for a professional dialogue between equal partners. This has to accompany each peer review that aims at an improvement in quality of critical patient care.

PROSAFE: a European endeavor to improve quality of critical care medicine in seven countries.

Long-lasting shared research databases are an important source of epidemiological information and can promote comparison between different healthcare services. Here we present PROSAFE, an advanced international research network in intensive care medicine, with the focus on assessing and improving the quality of care. The project involved 343 ICUs in seven countries. All patients admitted to the ICU were eligible for data collection. The PROSAFE network collected data using the same electronic case report form translated into the corresponding languages. A complex, multidimensional validation system was implemented to ensure maximum data quality. Individual and aggregate reports by country, region, and ICU type were prepared annually. A web-based data-sharing system allowed participants to autonomously perform different analyses on both own data and the entire database. The final analysis was restricted to 262 general ICUs and 432,223 adult patients, mostly admitted to Italian units, where a research network had been active since 1991. Organization of critical care medicine in the seven countries was relatively similar, in terms of staffing, case mix and procedures, suggesting a common understanding of the role of critical care medicine. Conversely, ICU equipment differed, and patient outcomes showed wide variations among countries. PROSAFE is a permanent, stable, open access, multilingual database for clinical benchmarking, ICU self-evaluation and research within and across countries, which offers a unique opportunity to improve the quality of critical care. Its entry into routine clinical practice on a voluntary basis is testimony to the success and viability of the endeavor.

Impact of Geographical Cohorting in the ICU: An Academic Tertiary Care Center Experience.

This is a retrospective analysis of quality metrics collected 12 months pre- and post-implementation of geographical cohorting. A total of 130 bedded ICU at tertiary academic health center in Midwest. All patients admitted to the ICU. Our institution piloted the geographical cohorting model for critical care physician rounding on September 1, 2018. The quality metrics were categorized as ICU harm events and ICU hospital metrics. Team of critical care providers were surveyed 12 months after implementation. The critical care utilization in the pre- and post-implementation numbers were similar for patient days (pre = 34,839, post = 35,155), central-line days (pre = 17,648, post = 19,224), and Foley catheter days (pre = 18,292, post = 17,364). The ICU length of stay was similar (4.9 d) in both pre- and post-intervention periods. Significant reduction in the incidence of Clostridium difficile infection (relative risk, -0.50; 95% CI, 0.25-0.96; p = 0.039), hospital-acquired pressure injury (relative risk, -0.60; 95% CI, 0.39-0.92; p = 0.020), central line-associated bloodstream infection incidence (relative risk, -0.19; 95% CI, 0.05-0.52; p = 0.008), and catheter-associated urinary tract infection (relative risk, -0.52; 95% CI, 0.29-0.93; p = 0.027). Healthcare providers perceived optimal utilization of their time, reduced interruptions, and improved coordination of care with geographical rounding. Geographical cohorting improves coordination of care, physician workflow, and critical care quality metrics in very large ICUs.

Novel mechanical ventilator weaning predictive model.

Mechanical ventilation (MV) is a common life support system in intensive care units. Accurate identification of patients who are capable of being extubated can shorten the MV duration and potentially reduce MV-related complications. Therefore, prediction of patients who can successfully be weaned from the mechanical ventilator is an important issue. The electronic medical record system (EMRs) has been applied and developed in respiratory therapy in recent years. It can increase the quality of critical care. However, there is no perfect index available that can be used to determine successful MV weaning. Our purpose was to establish a novel model that can predict successful weaning from MV. Patients' information was collected from the Kaohsiung Medical University Hospital respiratory therapy EMRs. In this retrospective study, we collected basic information, classic weaning index, and respiratory parameters during spontaneous breathing trials of patients eligible for extubation. According to the results of extubation, patients were divided into successful extubation and extubation failure groups. This retrospective cohort study included 169 patients. Statistical analysis revealed successful extubation predictors, including sex; height; oxygen saturation; Glasgow Coma Scale; Acute Physiology and Chronic Health Evaluation II score; pulmonary disease history; and the first, 30th, 60th, and 90th minute respiratory parameters. We built a predictive model based on these predictors. The area under the curve of this model was 0.889. We established a model for predicting the successful extubation. This model was novel to combine with serial weaning parameters and thus can help intensivists to make extubation decisions easily.

Patient and Family Member Experiences in Critical Care Research and Quality Improvement Projects.

Public and patient involvement in healthcare research is increasing, but the effect of involvement on individuals, service delivery, and health outcomes-particularly in specialist population groups like critical care-remains unclear, as does the best way to involve people who have experienced critical illness. The aim of the study was to explore former patients' and family members' views and experiences of involvement in critical care research and/or quality improvement. Using a qualitative methodology, semistructured telephone interviews were conducted with seven former intensive care unit patients and three close family members across England. Data were analyzed using a standard process of inductive thematic analysis. Four key themes were identified: making it happen, overcoming hurdles, it helps, and respect and value. Findings center on the need for flexibility, inclusivity, and transparency. They further highlight the particular challenges faced by critical illness survivors and their family members in relation to research involvement, the importance of individualized support and training, and the vital role that project leads have in making people feel valued and equal partners in the process. This is the first study to explore patients' experiences of involvement in critical care research. Despite the small, homogenous sample, the study provides valuable and important data to guide future practice. It highlights the need to enable and support people to make informed choices at a time when they are ready to do so. It further highlights the importance of gatekeepers to avoid vulnerable people contributing before they are ready-a practice that could negatively affect their health status.

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

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. 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. 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). 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.