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Infection surveillance in Intensive care

Dr C ClarkeConsultant in Intensive Care Medicine & Anaesthesia

Craigavon Area Hospital

Surveillance

The systematic collection and analysis of data on nosocomial infection occurrences

Incidence of nosocomial infection

ID patterns and potential solutions

Outcome objectives (IHI)

Surveillance

Requires cooperation between infection control and ICU

Agree the aims and goals

Ensure quality of ICU care

Surveillance

Expensive and labour intensive

Accuracy- over and under diagnosis eg miss outbreak/cluster

Benchmarking-eg comparing a cancer hospital with Burns Unit

Potential for data to be hidden

Those that do worst at finding infection-”look the best”

Surveillance

Well established CDC (USA-centre for disease control)

KISS - Krankenhaus Infektions Surveillance Systems

Tend to underestimate

Benchmark infection rates and establish standards of preventative care

Confidential, Voluntary, Methodologically sound

Outcomes

CVC infection rates 2.1-1,5 Bloodstream infections per 1000 CVC days (29% reduction

Neonatal Unit –No change in infection rates over 10 years

Overall the evidence supports this approach

Key points

A surveillance program should be in place to monitor the incidence and features of local nosocomial infection and to help develop strategies to decrease the incidence of infection in the ICU

Handwashing and specific isolation protocols key factors

CVCs, indwelling catheters and ventilation-discontinue ASAP

Quality Indicators-according to ICS

20 indicators in order of importance 3 hand hygiene 6 unit acquired bacteraemias 7 unit acquired MRSA infection 8 catheter related blood stream infection 9 unit acquired C. Difficle 12 Appropriate infection isolation

Colonisation v infection

Clinical indicators of infection

Colonisation common of respiratory and urinary tracts in ICU

SIRS often present due to non-infective causes

CRP PCT

Quantitative culture (eg >106 cfu/ml of resp secretion)

Immunocompromised?

ICS

CDC Definitions

a nosocomial infection as a localized or systemic condition 1) that results from adverse reaction to the presence of an infectious agent(s) or its toxin(s) and 2) that was not present or incubating at the time of admission to the hospital (7, and NNIS Manual, Section XIII, May 1994, unpublished). For most bacterial nosocomial infections, this means that the infection usually becomes evident 48 hours (i.e., the typical incubation period) or more after admission.

A central line associated blood stream infection is a laboratory-confirmed bloodstream infection (BSI) in a patient who had a central line within the 48 hour period before the development of the BSI and that is not related to an infection at another site.

The CLABSI must meet one of the following criteria:

Criterion 1Patient has a recognised pathogen cultured from one or more blood culturesandOrganism cultured from blood is not related to an infection at another site.

Criterion 2Patient has at least one of the following signs or symptoms: fever (>38°C), chills, or hypotensionandsigns and symptoms and positive laboratory results are not related to an infection at another siteandCommon skin contaminant is cultured from two or more blood cultures drawn on separate occasions

Criterion 3Patient < 1 year of age has at least one of the following signs or symptoms: fever (>38°C core) hypothermia (<36°C core), apnoea, or bradycardiaand Signs and symptoms and positive laboratory results are not related to an infection at another siteand Common skin contaminant is cultured from two or more blood cultures drawn on separate occasions.

Summary

Surveillance is an integral of Intensive Care

Dependent of data collection

Definitions are complex

Microbiology must always be interpreted with clinical information.