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Central-Line–Associated Bloodstream Infections in Québec Intensive Care Units: Results from the Provincial Healthcare-Associated Infections Surveillance Program (SPIN)

Published online by Cambridge University Press:  19 July 2016

Lynne Li ,
Elise Fortin ,
Claude Tremblay ,
Muleka Ngenda-Muadi ,
Caroline Quach  and
for SPIN-BACC
Lynne Li
Affiliation:
Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal (QC), Canada
Elise Fortin
Affiliation:
Institut National de Santé Publique du Québec, Québec and Montréal (QC), Canada
Claude Tremblay
Affiliation:
Institut National de Santé Publique du Québec, Québec and Montréal (QC), Canada Centre Hospitalier Universitaire de Québec - Pavillon Hôtel-Dieu de Québec, Québec City (QC), Canada
Muleka Ngenda-Muadi
Affiliation:
Institut National de Santé Publique du Québec, Québec and Montréal (QC), Canada
Caroline Quach*
Affiliation:
Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal (QC), Canada Institut National de Santé Publique du Québec, Québec and Montréal (QC), Canada Research Institute, McGill University Health Centre, Montreal (QC), Canada Department of Pediatrics, The Montreal Children’s Hospital of the McGill University Health Centre, McGill University, Montreal (QC), Canada
*
Address correspondence to Dr. Caroline Quach - McGill University Health Center, E05-1954 – 1001 Decarie Boulevard, Montreal, QC H4A 3J1, Canada ([email protected]).
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Abstract

BACKGROUND

Following implementation of bundled practices in 2009 in Quebec and Canadian intensive care units (ICUs), we describe CLABSI epidemiology during the last 8 years in the province of Québec (Canada) and compare rates with Canadian and American benchmarks.

METHODS

CLABSI incidence rates (IRs) and central venous catheter utilization ratios (CVCURs) by year and ICU type were calculated using 2007–2014 data from the Surveillance Provinciale des Infections Nosocomiales (SPIN) program. Using American and Canadian surveillance data, we compared SPIN IRs to rates in other jurisdictions using standardized incidence ratios (SIRs).

RESULTS

In total, 1,355 lab-confirmed CLABSIs over 911,205 central venous catheter days (CVC days) were recorded. The overall pooled incidence rate (IR) was 1.49 cases per 1,000 CVC days. IRs for adult teaching ICUs, nonteaching ICUs, neonatal ICUs (NICUs), and pediatric ICUs (PICUs) were 1.04, 0.91, 4.20, and 2.15 cases per 1,000 CVC days, respectively. Using fixed SPIN 2007–2009 benchmarks, CLABSI rates had decreased significantly in all ICUs except for PICUs by 2014. Rates declined by 55% in adult teaching ICUs, 52% in adult nonteaching ICUs, and 38% in NICUs. Using dynamic American and Canadian CLABSI rates as benchmarks, SPIN adult teaching ICU rates were significantly lower and adult nonteaching ICUs had lower or comparable rates, whereas NICU and PICU rates were higher.

CONCLUSION

Québec ICU CLABSI surveillance shows declining CLABSI rates in adult ICUs. The absence of a decrease in CLABSI rate in NICUs and PICUs highlights the need for continued surveillance and analysis of factors contributing to higher rates in these populations.

Infect Control Hosp Epidemiol 2016;1–9

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 10 , October 2016 , pp. 1186 - 1194
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

1. Sydnor, ERM, Perl, TM. Hospital epidemiology and infection control in acute-care settings. Clin Microbiol Rev 2011;24:141–173.CrossRefGoogle ScholarPubMed
2. Zimlichman, E, Henderson, D, Tamir, O, et al. Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med 2013;173:2039–2046.Google Scholar
3. Fontela, PS, Platt, RW, Rocher, I, et al. Surveillance Provinciale des Infections Nosocomiales (SPIN) Program: implementation of a mandatory surveillance program for central line-associated bloodstream infections. Am J Infect Control 2011;39:329–335.Google Scholar
4. Fontela, PS, Quach, C, Buckeridge, D, Pai, M, Platt, RW. Surveillance length and validity of benchmarks for central line-associated bloodstream infection incidence rates in intensive care units. PloS One 2012;7:e36582.CrossRefGoogle ScholarPubMed
5. Dudeck, MA, Edwards, JR, Allen-Bridson, K, et al. National Healthcare Safety Network report, data summary for 2013, device-associated Module. Am J Infect Control 2015;43:206–221.Google Scholar
6. Public Health Agency of C. Central Venous Catheter-Associated Bloodstream Infections in Intensive Care Units in Canadian Acute-Care Hospitals: Surveillance Report January 1, 2006 to December 31, 2006 and January 1, 2009 to December 31, 2011. Public Health Agency of Canada; 2014. 55.Google Scholar
7. Fontela, PS, Platt, RW, Rocher, I, et al. Epidemiology of central line-associated bloodstream infections in Quebec intensive care units: a 6-year review. Am J Infect Control 2012;40:221–226.Google Scholar
8. O’Grady, NP, Alexander, M, Burns, LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011;52:e162–e193.Google Scholar
9. The Joint Commission. Preventing Central Line–Associated Bloodstream Infections: A Global Challenge, a Global Perspective. Oak Brook, IL: Joint Commission Resources; 2012/05// 2012.Google Scholar
10. Gonzales, M, Rocher, I, Fortin, E, et al. A survey of preventive measures used and their impact on central line-associated bloodstream infections (CLABSI) in intensive care units (SPIN-BACC). BMC Infect Dis 2013;13:562.Google Scholar
11. Edwards, JD, Herzig, CT, Liu, H, et al. Central line-associated blood stream infections in pediatric intensive care units: longitudinal trends and compliance with bundle strategies. Am J Infect Control 2015;43:489–493.Google Scholar
12. Fontela, PS, Rocher, I, Platt, RW, et al. Evaluation of the reporting validity of central line-associated bloodstream infection data to a provincial surveillance program. Infect Control Hosp Epidemiol 2013;34:217–219.CrossRefGoogle ScholarPubMed
13. Center of Disease Control and Prevention/National Health Surveillance Network. Bloodstream Infection Event (Central Line-Associated Bloodstream Infection and Non-central line–associated Bloodstream Infection) 2015. http://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf Google Scholar
14. Edwards, JR, Peterson, KD, Mu, Y, et al. National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control 2009;37:783–805.Google Scholar
15. Gustafson, TL. Practical risk-adjusted quality control charts for infection control. Am J Infect Control 2000;28:406–414.Google Scholar
16. Pittet, D, Allegranzi, B, Boyce, J. The World Health Organization Guidelines on hand hygiene in health care and their consensus recommendations. Infect Control Hosp Epidemiol 2009;30:611–622.CrossRefGoogle ScholarPubMed
17. Saman, DM, Kavanagh, KT, Abusalem, SK. Redefining the standardized infection ratio to aid in consumer value purchasing. J Patient Saf 2013;9:55–58.Google Scholar
18. Dudeck, MA, Horan, TC, Peterson, KD, et al. National Healthcare Safety Network report, data summary for 2011, device-associated module. Am J Infect Control 2013;41:286–300.Google Scholar
19. Dudeck, MA, Horan, TC, Peterson, KD, et al. National Healthcare Safety Network (NHSN) Report, data summary for 2010, device-associated module. Am J Infect Control 2011;39(10):798–816.CrossRefGoogle Scholar
20. Dudeck, MA, Horan, TC, Peterson, KD, et al. National Healthcare Safety Network (NHSN) report, data summary for 2009, device-associated module. Am J Infect Control 2011;39(5):349–367.CrossRefGoogle ScholarPubMed
21. Dudeck, MA, Weiner, LM, Allen-Bridson, K, et al. National Healthcare Safety Network (NHSN) report, data summary for 2012, device-associated module. Am J Infect Control 2013;41(12):1148–1166.Google Scholar
22. Hansen, S, Schwab, F, Schneider, S, Sohr, D, Gastmeier, P, Geffers, C. Time-series analysis to observe the impact of a centrally organized educational intervention on the prevention of central-line-associated bloodstream infections in 32 German intensive care units. J Hosp Infect 2014;87:220–226.Google Scholar
23. Worth, LJ, Spelman, T, Bull, AL, Brett, JA, Richards, MJ. Central line-associated bloodstream infections in Australian intensive care units: time trends in infection rates, etiology, and antimicrobial resistance using a comprehensive Victorian surveillance program, 2009–2013. Am J Infect Control 2015;43:848–852.Google Scholar
24. Young, JQ, Ranji, SR, Wachter, RM, Lee, CM, Niehaus, B, Auerbach, AD. “July effect”: impact of the academic year-end changeover on patient outcomes: a systematic review. Ann Intern Med 2011;155:309–315.Google Scholar
25. Paquet, F, Frenette, C, Patterson, C, Decary, A. Impact of an eight-year program to reduce central line-associated blood stream infection (CLABSI) in a University Teaching Hospital. Open Forum Infectious Diseases 2015;2:S117.Google Scholar
26. Gastmeier, P, Schwab, F, Sohr, D, Behnke, M, Geffers, C. Reproducibility of the surveillance effect to decrease nosocomial infection rates. Infect Control Hosp Epidemiol 2009;30:993–999.Google Scholar
27. Miller, MR, Griswold, M, Harris, JM 2nd, et al. Decreasing PICU catheter-associated bloodstream infections: NACHRI’s quality transformation efforts. Pediatrics 2010;125:206–213.Google Scholar
28. Milstone, AM, Reich, NG, Advani, S, et al. Catheter dwell time and CLABSIs in neonates with PICCs: a multicenter cohort study. Pediatrics 2013;132:e1609–e1615.Google Scholar
29. Huskins, WC. Quality improvement interventions to prevent healthcare-associated infections in neonates and children. Curr Opin Pediatr 2012;24:103–112.Google Scholar
30. Smulders, CA, van Gestel, JP, Bos, AP. Are central line bundles and ventilator bundles effective in critically ill neonates and children? Intensive Care Med 2013;39:1352–1358.Google Scholar
31. Fisher, D, Cochran, KM, Provost, LP, et al. Reducing central line-associated bloodstream infections in North Carolina NICUs. Pediatrics 2013;132:e1664–e1671.CrossRefGoogle ScholarPubMed
32. McMullan, C, Propper, G, Schuhmacher, C, et al. A multidisciplinary approach to reduce central line-associated bloodstream infections. Joint Comm J Qual Patient Safety 2013;39:61–69.Google Scholar
33. Neill, S, Haithcock, S, Smith, PB, et al. Sustained reduction in bloodstream infections in infants at a large tertiary care neonatal intensive care unit. Adv Neonat Care 2016;16:52–59.Google Scholar
34. Aziz, K, McMillan, DD, Andrews, W, et al. Variations in rates of nosocomial infection among Canadian neonatal intensive care units may be practice-related. BMC Pediatr 2005;5:22.Google Scholar