Bloodstream Infection (BSI) Surveillance in Critical Care Units at Nopparatrajathanee Hospital, 2017

Abstract

Healthcare-associated bloodstream infections (HA-BSI) related to mortality and morbidity are often caused by bacteria and classified as primary or secondary infections. However, this current definition BSI did not include the report of secondary BSI to the surveillance system. The identification of a new infection was not clear when new organisms were reported. United States Centers for Disease Control and Prevention (US-CDC) assisted Department of Medical Services to develop the definition of BSI used from 2013 to 2017. The new definition clarified the timing of HA-BSIs with simplifying measurements from hourly to calendar day units and included report of the secondary BSI. The BSI in the ICU units was audited by infection control nurses. The researchers used an electronic data collection form for retrospective chart review. Charts were selected based on a hospitalized list of ICU patients with a positive blood culture during January to December 2017. Data were reviewed to determine if the blood cultures met the 2017 BSI definitions. The results of those were compared with the data collected by the current definition. A total of 174 ICU patients with a positive blood cultures were reviewed and 60 episodes (34.4%) met this HA-BSI following the 2017 BSI definitions. BSI was classified as HA-BSI in 95% and present on admission (POA) in 5%. The totalHA-BSI rate was 2.4 per 1,000 patient-days, the primary BSI rate was 1.4 per 1,000 patient- days and CLABSI rate was 2.6 per 1,000 central-line days. The secondary BSI rate was 1.0 per 1,000 patient-days. By current definition, the total BSI rate was 0.8 per 1,000 patient-days and CLABSI rate was 1.2 per 1,000 central-line days. Those results will be analyzed to effective problem solving regarding the cause of HA-BSI infections. The rate of CLABSI identified using the current definition was lower than that using the 2017 CDC definition. This lower rate may be the current definitions are unclear as to the duration time of the new infection.