Scottish Surveillance of Healthcare Associated Infection Programme (SSHAIP)

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SSHAIP

HAI in Intensive Care Unit Surveillance

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.

Background

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 countries.

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.