The Scottish Surveillance of Healthcare Associated Infection Programme (SSHAIP)
team at Health Protection Scotland (HPS) and the Scottish Intensive Care Society
Audit Group (SICSAG) have collaborated to develop a system for surveillance of infections
acquired in the ICU. It is intended that ICU infection data will be collected through
the SICSAG Ward Watcher audit system currently in place in intensive care units
throughout Scotland. The case definitions, data definitions and data required are
those specified by the HELICS protocol for Surveillance of Nosocomial Infections
in Intensive Care Units. This protocol for surveillance of ICU acquired infections
is based on the infection definitions and methodology developed by HELICS for ICU
acquired infection surveillance.
Project Lead: Dr Jodie McCoubrey , Epidemiologist, HAI Surveillance
HAI in ICU Surveillance Pilot Study
A pilot study to evaluate the use of Ward Watcher as a data collection system for
surveillance in the ICU and to evaluate the applicability of the data definitions
in the ICU was carried out between May and August 2005.
Healthcare associated infections (HAI) affect around 9% of patients in hospital
(Emmerson et al, 1996). It is generally accepted that the infection rate in the
intensive care unit (ICU) is likely to be higher as patients in the ICU are critically
ill and are subject to invasive procedures which increase their risk of acquiring
a healthcare associated infection. A number of published studies have been carried
out to determine rates of infections in intensive care units, however these figures
vary considerably between studies and depend on the type of ICU and the infection
definitions used in the study (Vincent et al, 2003).
The European Prevalence of Infection in Intensive Care (EPIC) study, a one-day prevalence
study of patients in intensive care units in Europe found that 21% of patients investigated
had an ICU acquired infection (ICUAI), according to the CDC definitions for HAI.
The rates of ICUAI varied from 9.7% in Switzerland to 31.6% in Italy and the UK
had an ICUAI rate of 16%. Those infections most frequently reported were pneumonias
(46.9%), lower respiratory tract infections (17.9%), urinary tract infections (17.6%)
and bloodstream infections (12%), (Vincent et al, 1995).
Another large study of nearly 500,000 patients in combined medical-surgical intensive
care units in 152 United States hospitals reported the incidence of ICUAI at 16.2
per 1000 patient days, this study used the NNIS definitions and included all types
of infection originating in the ICU (Richards et al, 2000).
Aims of surveillance of HAI in ICU
To provide intensive care units with the necessary reference data to make comparisons
of risk-adjusted rates between units/hospitals within Scotland and other European
To follow-up epidemiological trends in time by:
Identification of important nosocomial pathogens
Epidemiology of emerging infections
Surveillance of HAI in ICUs in Scotland
Data collection in Scotland will comprise of HELICS Level 2 surveillance of Blood
Stream Infections (BSI), Catheter Related Infections (CRI) and Ventilator Associated
Pneumonia (VAP). This surveillance permits risk-adjusted rates for comparison of
infection rates between ICUs (benchmarking). Risk factors are collected for every
patient staying in the ICU, whether infected or not (patient-based surveillance).
In order to obtain sufficient precision of indicators, a minimum surveillance period
of six months is recommended.