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Inter-unit comparisons of intensive care unit-acquired catheter-associated bloodstream infection rates in Cyprus and Greece

Abstract number: P1184

Kritsotakis E., Bagatzouni D., Alexandrou M., Zinieri V., Roumbelaki M., Dimitriadis I., Gikas A.

Objective: Surveillance of intensive care unit (ICU) acquired infections has become an integral part of infection control programmes in several countries, and outcome and process indicators are increasingly used in benchmarking the quality of medical care. The objective of this study was to implement a standardised protocol for the surveillance of ICU-acquired bloodstream infections and assess its usefulness in a network of hospitals in Cyprus and Greece.

Methods: The study was conducted in the medical-surgical ICUs of 4 public hospitals in Cyprus and 5 public hospitals in the region of Crete in Greece. All patients admitted to the ICUs during an 11-month period were actively monitored for central line-associated bloodstream infection (CL-BSI) until their discharge or death. The US National Nosocomial Infections Surveillance system's methods were applied. For inter-unit comparisons, the central line (CL) use ratio [(number of CL days)/(number of patient-days)] was utilised as a process indicator and the CL-BSI rate [(number of primary CL-BSIs)/(number of CL-days)×1000] was used as an outcome indicator.

Results: During the study period, a total of 3941 patients were admitted to the study ICUs, for a mean length of stay of 5.8 days. A total of 233 primary BSIs were recorded, of which 91.8% were associated with the use of CL. Overall CL-BSI rates were high in both regions: 14.6 and 18.6 cases per 1000 CL-days in Cretan and Cypriot ICUs, respectively. CL-BSI rates varied widely among participating units, ranging from 3.7 to 22.9 cases per 1000 CL-days. CL use ratios also had significant inter-unit variation, ranging from 0.12 to 0.96. A simultaneous analysis of the two indicators is shown in the Figure. Two units (CY-1 and CR-1) were identified as having both measurements high (above the mean values represented by the solid lines), suggesting that these units need to review their practices for appropriate use of CL. One unit (CY-2) had a high CL-BSI rate despite its low CL utilisation ratio, suggesting that the unit needs to review CL insertion and maintenance practices.

Conclusion: ICU-acquired bloodstream infections constitute a major problem in the two study regions. Simultaneous analysis of CL-BSI rates and CL-use ratios was useful for identifying initial targets for corrective interventions to improve CL management practices and reduce infection rates in the ICUs studied.

Session Details

Date: 16/05/2009
Time: 00:00-00:00
Session name: 19th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Helsinki, Finland, 16 - 19 May 2009
Presentation type:
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