Central and peripheral line-associated bloodstream infections in Australian neonatal and paediatric intensive care units: findings from a comprehensive Victorian surveillance network, 2008–2016
Introduction
Healthcare-associated infections (HCAIs) in neonatal and paediatric populations are associated with poorer clinical outcomes and significant healthcare costs [1], [2]. Surveillance is an important and necessary component of prevention programmes, enabling burden of illness, trends, and the impact of quality improvement initiatives to be evaluated [3].
Over the last two to three decades, monitoring of healthcare-associated infections in paediatric populations has been performed by a number of international networks using standardized methods [4], [5], [6]. A reduction in overall burden of illness has been demonstrated by many centres following the implementation of multi-modal prevention strategies in paediatric and neonatal intensive care units (ICUs) [7], [8], [9], [10]. In Australia, sepsis is monitored in neonatal ICUs, but no national strategy for monitoring device-related healthcare-associated infections has been developed for neonatal and paediatric ICU populations [11].
In 2002, the Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre was established regionally to monitor a range of processes and outcomes relevant to HCAIs in adult and paediatric patient populations in Victoria [12]. Central line-associated bloodstream infection (CLABSI) and peripheral line-associated bloodstream infection (PLABSI) are continuously monitored in Victorian neonatal ICUs, and CLABSI is monitored in the paediatric ICU. The objectives of this study were to evaluate surveillance findings to determine: (i) the burden of illness, (ii) pathogens responsible for infections, and (iii) time-trends in infection rates for CLABSI and PLABSI in neonatal and paediatric ICUs.
Section snippets
Methods
The VICNISS Coordinating Centre was established for the purpose of monitoring a range of HCAI outcomes and relevant processes in adult and paediatric patients in Victorian hospitals, including CLABSI and PLABSI. VICNISS surveillance methods are based on methods employed by the Centers for Disease Control/National Healthcare Safety Network (CDC/NHSN). For our study, data collected by paediatric centres between July 1st, 2008, and December 31st, 2016, were analysed. This period enabled comparable
Results
During the study period, the median age of neonatal patients with infection was 18 days (IQR: 10–36), and 59.1% events occurred in male patients. For paediatric patients, the median age was 0.7 years (IQR: 0.26–6.21), and 54.9% events occurred in male patients.
Discussion
Our network is the first in Australia to monitor and evaluate the epidemiology of line-associated bloodstream infections in neonatal and paediatric ICUs, including aetiology, disease burden, and trends over time. CLABSI rates in neonatal and paediatric patients were ∼2 per 1000 CVC-days, with a significant reduction in neonatal events over time. By contrast, there was a lower overall PLABSI rate of 0.67 per 1000 peripheral line-days. The most frequent pathogens responsible for CLABSI were
Acknowledgements
Infection prevention staff at participating facilities are acknowledged for data collection and surveillance activities.
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