Data on the incidence of hospital-wide acquired bloodstream infection (BSI) and the best ways to reduce it are lacking. Our aim was to increase hospital-wide awareness and decrease incidence of hospital-acquired (HA) -BSI through self-investigation.
Meir Medical Center is a 740-bed hospital. Beginning in January 2016, reports of HA-BSI events were sent daily to the wards with requests to investigate the source of infection, and preventability using a structured questionnaire. The infection control staff gave immediate feedback to the wards regarding their investigation. A summary of the results was sent to all wards and to hospital management quarterly. Interrupted time series analysis was used to compare the monthly rate of HA-BSI before and after the intervention. We estimated the number of cases prevented by the intervention by applying the HA-BSI rate in 2015 to the number of admissions in 2016-2017 and comparing the observed number of cases to the expected if the rate had not changed.
In 2016 64% of HA-BSI underwent investigation by the wards; this increased to 78% in 2017. As illustrated in the Figure, before the intervention, the HA-BSI rate per 1000 admissions increased by 0.11 per month (not significant P=0.15). In the first month of the intervention, the HA-BSI rate decreased significantly by 0.43 (P=0.04, 95% CI: -0.84- -0.02). The HA-BSI rate continued to decrease (relative to the pre-intervention period) by 0.045 per month (P=0.05, 95% CI: -.09 - 0.00). During these 3 years there was no significant change in the rate of community-acquired BSI (8.46, 8,88, 8,58, P for trend = 0.83) or in the rate of blood cultures drawn. During the intervention, the rate of HA-BSI decreased in both ICU units and in non-ICU wards. The number of HA-BSI caused by Enterobacteriaceae decreased from 170 in 2015 to 116 in 2017. S. aureus decreased from 51 to 30 and Candida from 11 to 0. The most common sources of BSI were urinary tract infection (31.4%) and central line associated BSI (16.4%). All-cause 30-day mortality for patients with HA- BSI was 30%. We estimated that in 2016-2017, 200 cases of HA-BSI and 60 deaths were prevented.
Increase awareness to HA BSI through self-investigation by the wards led to hospital-wide significant reduction in HA-BSI.
B. Gerber, None
H. Lederman, None
M. Maram, None
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